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| ==Case Studies== | | ==Case Studies== |
| [[Sporotrichosis case study one|Case#1]] | | [[Sporotrichosis case study one|Case#1]] |
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| ==Treatment==
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| Treatment of sporotrichosis depends on the severity and location of the disease. The following are treatment options for this condition:<ref>{{cite journal |author=Lortholary O, Denning DW, Dupont B |title=Endemic mycoses: a treatment update |journal=J. Antimicrob. Chemother. |volume=43 |issue=3 |pages=321–31 |year=1999 |pmid=10223586 |url=http://jac.oxfordjournals.org/cgi/content/full/43/3/321 |doi=10.1093/jac/43.3.321}}</ref>
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| *Saturated [[potassium iodide]] solution
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| :Although its mechanism is unknown, application of potassium iodide in droplet form can cure cutaneous sporotrichosis. This usually requires 3 to 6 months of treatment.
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| *[[Itraconazole]] (Sporanox) and [[fluconazole]]
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| :These are [[Antifungal medication|antifungal]] drugs. Itraconazole is currently the drug of choice and is significantly more effective than fluconazole. Fluconazole should be reserved for patients who cannot tolerate itraconazole.
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| *[[Amphotericin B]]
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| :This antifungal medication is delivered intravenously. Many patients, however, cannot tolerate Amphotericin B due to its potential side effects of fever, nausea, and vomiting.
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| Lipid formulations of amphotericin B are usually recommended instead of amphotericin B deoxycholate because of a better adverse-effect profile. Amphotericin B can be used for severe infection during pregnancy. For children with disseminated or severe disease, amphotericin B deoxycholate can be used initially, followed by itraconazole.<ref name="dbt.consultantlive.com">Hogan BK, Hospenthal DR. [http://dbt.consultantlive.com/display/article/1145628/1545568 Update on the therapy for sporotrichosis]. Drug Benefit Trends. 2010;22:49-52.</ref>
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| :In case of sporotrichosis meningitis, the patient may be given a combination of Amphotericin B and 5-fluorocytosine/[[Flucytosine]].
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| *Newer [[triazole]]s
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| Several studies have shown that [[posaconazole]] has in vitro activity similar to that of amphotericin B and itraconazole; therefore, it shows promise as an alternative therapy. However, [[voriconazole]] susceptibility varies. Because the correlation between in vitro data and clinical response has not been demonstrated, there is insufficient evidence to recommend either posaconazole or voriconazole for treatment of sporotrichosis at this time.<ref name="dbt.consultantlive.com"/>
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| *[[Surgery]]
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| :In cases of bone infection and cavitatory nodules in the lungs, surgery may be necessary.
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| ===Antimicrobial Regimen===
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| *'''Sporotrichosis'''<ref name="KauffmanBustamante2007">{{cite journal|last1=Kauffman|first1=C. A.|last2=Bustamante|first2=B.|last3=Chapman|first3=S. W.|last4=Pappas|first4=P. G.|title=Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=45|issue=10|year=2007|pages=1255–1265|issn=1058-4838|doi=10.1086/522765}}</ref>:
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| :*1.'''Lymphocutaneous/cutaneous'''
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| ::*Preferred regimen: [[Itraconazole]] 200mg PO qd
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| ::*Alternative regimen (1): [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen (2): [[Terbinafine]] 500 mg bid
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| ::*Alternative regimen (3): Saturated solution potassium iodide(SSKI) with increasing doses
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| ::*Alternative regimen (4): [[Fluconazole]] 400–800 mg qd
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| ::*Alternative regimen (5): local hyperthermia
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| ::*Note(1): Treat for 2–4 weeks after lesions resolved
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| ::*Note(2): SSKI initiated at a dosage of 5 drops (using a standard eyedropper) 3 times daily, increasing as tolerated to 40–50 drops 3 times daily
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| :*2.'''Osteoarticular'''
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| ::*Preferred regimen: [[Itraconazole]] 200mg PO bid for 12 months
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| ::*Alternative regimen (1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day
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| ::*Alternative regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day
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| ::*Note(1): Switch to [[Itraconazole]] after favorable response if AmB used
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| ::*Note(2): Treat for a total of at least 12 months
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| :*3.'''Pulmonary'''
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| ::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day for severe or life-threatening pulmonary sporotrichosis, then [[Itraconazole]] 200 mg PO bid
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| ::*Preferred regimen(2): [[Itraconazole]] 200 mg PO bid for 12 months for less severe disease
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d, then [[Itraconazole]] 200 mg PO bid {{or}} surgical removal
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| ::*Note(1): Treat severe disease with an AmB formulation followed by [[Itraconazole]]
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| ::*Note(2): Treat less severe disease with [[Itraconazole]]
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| ::*Note(3): Treat for a total of at least 12 monthsSurgery combined with amphotericin B therapy is rec- ommended for localized pulmonary disease
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| :*4.'''Meningitis'''
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| ::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg daily for 4–6 weeks, then [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d, then [[Itraconazole]] 200 mg PO bid
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| ::*Note(1): Length of therapy with AmB not established, but therapy for at least 4–6 weeks is recommended.
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| ::*Note(2): Treat for a total of at least 12 months.
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| ::*Note(3): May require long-term suppression with [[Itraconazole]].
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| :*5.'''Disseminated'''
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| ::*Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
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| ::*Note(1): Therapy with AmB should be continued until the patient shows objective evidence of improvement.
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| ::*Note(2): Treat for a total of at least 12 months.
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| ::*Note(3): May require long-term suppression with [[Itraconazole]].
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| :*6.'''Pregnant women'''
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| ::*Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day {{or}} [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day for severe sporotrichosis
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| ::*Preferred regimen(2): Local hyperthermia for cutaneous disease.
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| ::*Note(1): It is preferable to wait until after delivery to treat non–life-threatening forms of sporotrichosis.
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| ::*Note(2): Azoles should be avoided.
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| :*7.'''Children'''
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| ::*Preferred regimen:
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| :::*Mild disease: [[Itraconazole]] 6–10 mg/kg/day (400 mg/day maximum)
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| :::*Severe disease: [[Amphotericin B]] deoxycholate 0.7 mg/kg/day followed by [[Itraconazole]] 6–10 mg/kg up to a maximum of 400 mg PO daily, as step-down therapy
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| ::*Alternative regimen: Saturated solution potassium iodide(SSKI) with increasing doses for mild disease initiated at a dosage of 1 drop (using a standard eyedropper) 3 times daily and increased as tolerated up to a maximum of 1 drop/kg or 40–50 drops 3 times daily, whichever is lowest
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| ==References== | | ==References== |