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"Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America"

current
Published: Clinical Infectious Diseases ; 2007 ; 45 : 1255 -1256

Abstract

Guidelines for the management of patients with sporotrichosis were prepared by an Expert Panel of the Infectious Diseases Society of America and replace the guidelines published in 2000... They include evidence-based recommendations for the management of patients with lymphocutaneous, cutaneous, pulmonary, osteoarticular, meningeal, and disseminated sporotrichosis. Recommendations are also provided for the treatment of sporotrichosis in pregnant women and in children.

*Every 12 to 18 months following publication, IDSA reviews its guidelines to determine whether an update is required. This guideline was last reviewed and deemed current as of 04/2013

Recommendations

Lymphocutaneous and Cutaneous Sporotrichosis

  1. For cutaneous and lymphocutaneous sporotrichosis, itraconazole 200 mg orally daily is recommended to be given for 2–4 weeks after all lesions have resolved, usually for a total of 3–6 months (A-II).
  2. Patients who do not respond should be given a higher dosage of itraconazole (200 mg twice daily; A-II); terbinafine, administered at a dosage of 500 mg orally twice daily (A-II); or saturated solution of potassium iodide (SSKI), initiated at a dosage of 5 drops (using a standard eye-dropper) 3 times daily and increasing, as tolerated, to 40–50 drops 3 times daily (A-II).
  3. Fluconazole (400–800 mg daily) should be used only if the patient cannot tolerate these other agents (B-II).
  4. Local hyperthermia can be used for treating patients, such as pregnant and nursing women, who have fixed cutaneous sporotrichosis and who cannot safely receive any of the previous regimens (B-III).

Osteoarticular Sporotrichosis

  1. Itraconazole, administered at 200 mg orally twice daily for at least 12 months, is recommended (A-II).
  2. Amphotericin B, given as a lipid formulation at a dosage of 3–5 mg/kg daily, or amphotericin B deoxycholate, administered at a dosage of 0.7–1.0 mg/kg daily, can be used for initial therapy (B-III). After the patient has shown a favorable response, therapy can be changed to itraconazole administered at a dosage of 200 mg orally twice daily to complete a total of at least 12 months of therapy (B-III).
  3. Serum levels of itraconazole should be determined after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure (A-III).

Pulmonary Sporotrichosis

  1. For severe or life-threatening pulmonary sporotrichosis, amphotericin B, given as a lipid formulation at 3–5 mg/kg daily, is recommended (B-III). Amphotericin B deoxycholate, administered at a dosage of 0.7–1.0 mg/kg daily, could also be used (B-III).
  2. After the patient has shown a favorable response to amphotericin B, therapy can be changed to itraconazole (200 mg orally twice daily) to complete a total of at least 12 months of therapy (B-III).
  3. For less severe disease, itraconazole administered at 200 mg orally twice daily for at least 12 months is recommended (A-III).
  4. Serum levels of itraconazole should be determined after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure (A-III).
  5. Surgery combined with amphotericin B therapy is recommended for localized pulmonary disease (B-III).

Meningeal Sporotrichosis

  1. Amphotericin B, given as a lipid formulation at a dosage of 5 mg/kg daily for 4–6 weeks, is recommended for the initial treatment of meningeal sporotrichosis (B-III). Amphotericin B deoxycholate, administered at a dosage of 0.7–1.0 mg/kg daily, could also be used but was not preferred by the panel (B-III).
  2. Itraconazole (200 mg twice daily) is recommended as step-down therapy after the patient responds to initial treatment with amphotericin B and should be given to complete a total of at least 12 months of therapy (B-III).
  3. Serum levels of itraconazole should be determined after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure (A-III).
  4. For patients with AIDS and other immunosuppressed patients, suppressive therapy with itraconazole at a dosage of 200 mg daily is recommended to prevent relapse (B-III).

Disseminated (Systemic) Sporotrichosis

  1. Amphotericin B, given as a lipid formulation at a dosage of 3–5 mg/kg daily, is recommended for disseminated sporotrichosis (B-III). Amphotericin B deoxycholate (0.7–1.0 mg/kg daily) could also be used but was not preferred by the panel (B-III).
  2. Itraconazole (200 mg twice daily) is recommended as step-down therapy after the patient responds to initial treatment with amphotericin B and should be given to complete a total of at least 12 months of therapy (B-III).
  3. Serum levels of itraconazole should be determined after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure (A-III).
  4. Lifelong suppressive therapy with itraconazole (200 mg daily) may be required for patients with AIDS and other immunosuppressed patients if immunosuppression cannot be reversed (B-III).

Sporotrichosis in Pregnant Women and in Children

  1. Amphotericin B, given as a lipid formulation at a dosage of 3–5 mg/kg daily, or amphotericin B deoxycholate, given at a dosage of 0.7–1 mg/kg daily, is recommended for severe sporotrichosis that must be treated during pregnancy (B-III); azoles should be avoided.
  2. Local hyperthermia can be used for the treatment of cutaneous sporotrichosis in pregnant women (B-III).
  3. Itraconazole, administered at a dosage of 6–10 mg/kg to a maximum of 400 mg orally daily, is recommended for children with cutaneous or lymphocutaneous sporotrichosis (B-III).
  4. An alternative for children is SSKI initiated at a dosage of 1 drop (using a standard eye-dropper) 3 times daily, increasing, as tolerated, up to a maximum of 1 drop per kg of body weight or 40–50 drops 3 times daily, whichever is lowest (B-III).
  5. For children with disseminated sporotrichosis, amphotericin B (0.7 mg/kg daily) should be the initial therapy, followed by itraconazole (6–10 mg/kg, up to a maximum of 400 mg daily) as step-down therapy (B-III).

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