Sporotrichosis medical therapy

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

Overview

Because spontaneous resolution in cases of sporotrichosis is a rarity, the majority of patients require treatment. The recommended treatment regimens are largely empirical and predominantly based upon retrospective evaluations, case study reports, and nonrandomized control trials. The predominant therapy for sporotrichosis is itraconazole, which is used as the primary treatment in immunocompetent patients, and as a suppressive therapy in immunocompromised patients. The primary line of treatment for immunocompromised patients is amphotericin B.

Treatment

Because spontaneous resolution in cases of sporotrichosis is a rarity, the majority of patients require treatment. The recommended treatment regimens are largely empirical and predominantly based upon retrospective evaluations, case study reports, and nonrandomized control trials. The chart below outlines the effective treatment methods based upon the form of sporotrichosis displayed by an infected human host.

Form	Primary Line of Treatment	Alternative Treatment	Remarks/Other
Uncomplicated cutaneous	Itraconazole 200 mg PO qd	Itraconazole 200 mg PO bid, OR Terbinafine 500 mg PO bid, OR SSKI increasing doses from 5 drops tid for one month to 40-50 drops qd, OR Fluconazole 400-800 mg PO qd, OR Local hyperthermia	Continue treatment for 2-4 weeks after lesions resolve.
Osteoarticular	Itraconazole 200 mg PO bid	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	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	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	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.