Dermatologic Manifestations of Sporotrichosis Medication

Updated: Oct 17, 2019
  • Author: Scott D Miller, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Continue systemic therapy until clinical resolution is achieved, typically 4-6 months.

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Antifungal agents

Class Summary

These agents are used for fungicidal or fungistatic eradication of the infective organism S schenkii.

Amphotericin B (AmBisome)

Amphotericin B is produced by a strain of Streptomyces nodosus; it can be fungistatic or fungicidal. Amphotericin B binds to sterols, such as ergosterol, in the fungal cell membrane, causing intracellular components to leak with subsequent fungal cell death. This is the drug of choice for systemic disease, although more recent literature indicates itraconazole or terbinafine may replace amphotericin B as the drug of choice for systemic sporotrichosis.

Itraconazole (Sporanox)

Itraconazole is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450-dependent synthesis of ergosterol, a vital component of fungal cell membranes. Itraconazole is the drug of choice for cutaneous disease and second drug of choice (likely to soon be first DOC) for systemic disease. It is available as a 100-mg capsule.

Potassium iodide (SSKI, Pima)

Potassium iodide is a saturated solution containing approximately 142 g potassium iodide in 100 mL water. It inhibits thyroid hormone secretion. The mechanism of action against Sporothrix is unknown. It is the third drug of choice for cutaneous disease. Potassium iodide is not effective for systemic disease. It contains 8 mg of iodide per drop and may be mixed with juice or water for intake.

Fluconazole (Diflucan)

Fluconazole is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation. It is the fourth drug of choice for systemic disease, modestly effective and thus reserved for itraconazole-intolerant patients.

Terbinafine (Lamisil)

Terbinafine is a synthetic allylamine hypothesized to act by inhibiting squalene epoxidase, thus blocking synthesis of ergosterol, a vital component of fungal cell membranes. Terbinafine is an alternative for cutaneous disease, with promise for systemic disease.

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