Clinical Practice Guidelines
Clinical practice guidelines for the management of sporotrichosis have been issued by the Infectious Disease Society of America (IDSA). [27]
Per the IDSA Website, these guidelines are current as of October 2014. [28]
Lymphocutaneous/cutaneous sporotrichosis
Administer itraconazole at 200 mg/d.
In patients who do not respond, administer itraconazole at 200 mg twice daily, 500 mg twice daily, or add potassium iodide (see below).
In patients intolerant of itraconazole, administer fluconazole at 400-800 mg/d or local hyperthermia.
Osteoarticular sporotrichosis
Administer amphotericin B and switch to itraconazole after therapeutic response.
Administer amphotericin B lipid formulation at 3-5 mg/kg/d.
Administer amphotericin B deoxycholate at 0.7-1.0 mg/kg/d.
Administer itraconazole at 200 mg twice daily for at least 12 months.
Confirm serum therapeutic levels after 2 weeks.
Pulmonary sporotrichosis
Antifungals are administered for localized disease after surgery, and this is also for initial therapy for severe infections.
Administer amphotericin B and switch to itraconazole after therapeutic response.
Administer amphotericin B lipid formulation at 3-5 mg/kg/d.
Administer amphotericin B deoxycholate at 0.7-1.0 mg/kg/d.
Administer itraconazole at 200 mg twice daily for at least 12 months.
Confirm serum therapeutic levels after 2 weeks.
Meningeal and disseminated (systemic) sporotrichosis
Administer amphotericin B and switch to itraconazole after therapeutic response.
Administer amphotericin B lipid formulation at 3-5 mg/kg/d.
Administer amphotericin B deoxycholate at 0.7-1.0 mg/kg/d.
Administer itraconazole at 200 mg twice daily for at least 12 months.
Confirm serum therapeutic levels after 2 weeks.
Pregnancy
Administer amphotericin B lipid formulation at 3-5 mg/kg/d.
Administer amphotericin B deoxycholate at 0.7-1.0 mg/kg/d.
Avoid azoles.
Pediatric cutaneous sporotrichosis
Administer potassium iodide, 1 drop 3 times daily, increasing as tolerated to a maximum of 1 drop/kg or 40-50 drops 3 times daily, which ever is lowest.
Pediatric disseminated sporotrichosis
Administer amphotericin B deoxycholate at 0.7 mg/kg/d, followed by itraconazole at 6-10 mg/kg, not to exceed 400 mg/d.
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Close-up of an ulcerated nodule reveals the satellite lesions characteristic of lymphangitic (sporotrichoid) spread.
