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Home » Addiction Medicine

Drug Benefit Trends. Vol. 22 No. 2
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Antifungal Therapy 

Update on the Therapy for Sporotrichosis

By Brian K. Hogan, MD, MPH&TM and Duane R. Hospenthal, MD, PhD | March 10, 2010

Dr Hogan is a fellow in the infectious disease program at San Antonio Uniformed Services Health Education Consortium, San Antonio, Tex, and assistant professor of medicine at F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. Dr Hospenthal is chief of the infectious disease service at San Antonio Military Medical Center, Fort Sam Houston, Tex, and professor of medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences. The views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Air Force, Department of the Army, Department of Defense, or US government. The authors are employees of the US government. This work was prepared as part of their official duties and, as such, is not subject to copyright.


Sporotrichosis is a fungal infection that typically results in cutaneous or lymphocutaneous disease, although other, more severe, life-threatening manifestations do occur. This article reviews updated treatment guidelines, which state that itraconazole has become the preferred therapy for most forms of infection. Amphotericin B remains the mainstay of treatment for severe cases, but lipid formulations are now preferred because of their more favorable toxicity profile. Also, fluconazole has been shown to be less effective than itraconazole and is no longer recommended except as an alternative for cutaneous and lymphocutaneous disease. [Drug Benefit Trends. 2010;22:49-52]


Sporotrichosis is a fungal infection caused by the dimorphic fungus Sporothrix schenckii (Figure). It has a worldwide distribution and is associated with soil, vegetation, and wood.

Disease most commonly results from traumatic inoculation, which leads to infection of the skin and adjacent lymphatics. Pulmonary disease is presumed to occur via inhalation. Dissemination to or inoculation at other sites, including bones, joints, and the CNS, also occurs, although rarely.1

While person-to-person spread does not occur, zoonotic transmission involving cats as well as digging animals, such as armadillos, has been documented.2 Risk factors for serious disease include alcoholism and immunosuppression, such as that seen in patients with AIDS.3-6

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