Sporotrichosis medical therapy: Difference between revisions

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| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Itraconazole]] 200 mg PO qd
* [[Itraconazole]] 200 mg PO qd
| style="padding: 5px 5px; background: #F5F5F5;"  
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Itraconazole]] 200 mg PO bid, {{Or}}  
* [[Itraconazole]] 200 mg PO bid, {{Or}}  
* [[Terbinafine]] 500 mg PO bid, {{Or}}  
* [[Terbinafine]] 500 mg PO bid, {{Or}}  
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* Limposomal amphotericin B 3-5 mg/kg IV qd '''<u>OR</u>'''  
* Limposomal amphotericin B 3-5 mg/kg IV qd '''<u>OR</u>'''  
* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd until symptom resolution
* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd until symptom resolution
|For a total of 12 months, switch to [[Itraconazole]] after resolution/end of treatment.
| style="padding: 5px 5px; background: #F5F5F5;" |For a total of 12 months, switch to [[Itraconazole]] after resolution/end of treatment.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary
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* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd '''<u>THEN</u>'''  
* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd '''<u>THEN</u>'''  
* [[Itraconazole]] 200 mg PO bid upon symptom resolution
* [[Itraconazole]] 200 mg PO bid upon symptom resolution
|Treat less sever cases with a 12 month regimen of [[Itraconazole]].
| style="padding: 5px 5px; background: #F5F5F5;" |Treat less sever cases with a 12 month regimen of [[Itraconazole]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Meningeal
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Meningeal
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* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd '''<u>THEN</u>'''  
* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd '''<u>THEN</u>'''  
* [[Itraconazole]] 200 mg PO bid upon symptom resolution
* [[Itraconazole]] 200 mg PO bid upon symptom resolution
|Precise length of amphotericin B treatment varies. Suppressive treatment with [[Itraconazole]] is necessary.  
| style="padding: 5px 5px; background: #F5F5F5;" |Precise length of amphotericin B treatment varies. Suppressive treatment with [[Itraconazole]] is necessary.  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Dissimated
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Dissimated
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* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd '''<u>THEN</u>'''  
* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd '''<u>THEN</u>'''  
* [[Itraconazole]] 200 mg PO bid upon symptom resolution  
* [[Itraconazole]] 200 mg PO bid upon symptom resolution  
|Continue amphotericin B treatment until patient shows marked improvement for a minimum of 12 months. Suppressive treatment with [[Itraconazole]] is necessary.
| style="padding: 5px 5px; background: #F5F5F5;" |Continue amphotericin B treatment until patient shows marked improvement for a minimum of 12 months. Suppressive treatment with [[Itraconazole]] is necessary.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Sporotrichosis in pregnant women
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Sporotrichosis in pregnant women
| style="padding: 5px 5px; background: #F5F5F5;" | colspan="2" |
| colspan="2" | style="padding: 5px 5px; background: #F5F5F5;" |
* Treat with limposomal amphotericin B 3-5 mg/kg IV qd '''<u>OR</u>'''  
* Treat with limposomal amphotericin B 3-5 mg/kg IV qd '''<u>OR</u>'''  
* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd only for severe cases of sporotrichosis '''<u>OR</u>'''
* Deoxycholate amphotericin B 0.7-1 mg/kg IV qd only for severe cases of sporotrichosis '''<u>OR</u>'''

Revision as of 17:41, 13 January 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alison Leibowitz [2]

Treatment

Form Primary Line of Treatment Alternative Treatment Remarks/Other
Uncomplicated cutaneous Continue treatment for 2-4 weeks after lesions resolve.
Osteoarticular
  • Limposomal amphotericin B 3-5 mg/kg IV qd OR
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd until symptom resolution
For a total of 12 months, switch to Itraconazole after resolution/end of treatment.
Pulmonary
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd THEN
  • Itraconazole 200 mg PO bid upon symptom resolution
Treat less sever cases with a 12 month regimen of Itraconazole.
Meningeal
  • Limposomal amphotericin B 3-5 mg/kg IV qd THEN
  • Itraconazole 200 mg PO bid
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd THEN
  • Itraconazole 200 mg PO bid upon symptom resolution
Precise length of amphotericin B treatment varies. Suppressive treatment with Itraconazole is necessary.
Dissimated
  • Limposomal amphotericin B 3-5 mg/kg IV qd THEN
  • Itraconazole 200 mg PO bid.
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd THEN
  • Itraconazole 200 mg PO bid upon symptom resolution
Continue amphotericin B treatment until patient shows marked improvement for a minimum of 12 months. Suppressive treatment with Itraconazole is necessary.
Sporotrichosis in pregnant women style="padding: 5px 5px; background: #F5F5F5;" |
  • Treat with limposomal amphotericin B 3-5 mg/kg IV qd OR
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd only for severe cases of sporotrichosis OR
  • In cases of uncomplicated cutaneous, treat with only hyperthermia.
It is preferable to defer treatment in uncomplicated cases.
Sporotrichosis in Children
  • Itraconazole 6-10 mg PO qd to a max of 400 mg PO qd for mild cases OR
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd for severe cases
  • SSKI increasing doses equivalent to half the adult dose, continuing treatment for 2-4 weeks after resolution of symptoms.

[1]

References

  1. Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America (2007). "Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (10): 1255–65. doi:10.1086/522765. PMID 17968818.