Winn and colleagues18 also published a study demonstrating efficacy of itraconazole(Drug information on itraconazole) for osteoarticular disease. Among 6 patients, 1 patient did not respond to treatment with itraconazole 100 mg daily. The data from this study highlight the need for higher dosing for an extended period. AmB is a treatment alternative for patients with severe disease or treatment failure. Other agents are not recommended.
Pulmonary sporotrichosis. In patients with pulmonary sporotrichosis, initial treatment with AmB is recommended. Again, when a favorable response is noted, itraconazole can then be substituted to complete at least 12 months of therapy.
Itraconazole can be used initially in patients with less severe disease. Surgery can also be considered in combination with AmB for localized pulmonary disease, although this is now considered an alternative treatment.
Recommendations for treatment of pulmonary sporotrichosis are based on very limited clinical data. These data include a relatively small retrospective review done by Pluss and Opal19 in 1986.
Before the advent of azoles, surgery combined with antifungal treatment, such as AmB, was the preferred option. The current guidelines no longer recommend AmB for the full course of treatment. In the retrospective study by Sharkey-Mathis and colleagues,3 pulmonary sporotrichosis resolved in 3 patients treated with itraconazole.
Meningeal sporotrichosis. AmB is recommended for the initial treatment of meningeal disease on the basis of a number of case reports. The expert panel that wrote the 2007 guidelines recommended use of a lipid formulation at a dosage of 5 mg/kg/d. The optimal duration of treatment with AmB is unclear, but treatment should be continued for 4 to 6 weeks.
Combination antifungal therapy with itraconazole, fluconazole(Drug information on fluconazole), or flucytosine(Drug information on flucytosine) does not seem to provide any substantial advantage.20 Once the patient improves, he or she may be treated with twice-daily itraconazole to complete 12 months of therapy.
Data supporting this recommendation are lacking. Suppressive therapy with itraconazole 200 mg daily is recommended for patients who have AIDS and other patients with immunosuppression.
Disseminated sporotrichosis. Patients with disseminated sporotrichosis should also be treated with AmB. As with meningeal disease, treatment can be switched to itraconazole 200 mg twice daily after initial improvement. This should be continued for at least 12 months. Suppressive therapy may be required.