Efficacy

The classic treatment of sporotrichosis is a saturated solution of potassium iodide. It is started at a dose of 1 ml three time daily and the dose is increased dropwise until 4-6 ml is being administered three times daily.16,17 The solution is often associated with side-effects such as nausea, vomiting and swelling of the salivary glands. However, recently terbinafine, itraconazole and fluconazole have been used with some success in this infection.11,18-20

Saturated potassium iodide is still widely used because it is cheap. One unblinded randomised comparative study of 57 people with culture-confirmed sporotrichosis showed that there was no advantage in splitting the dose of potassium iodide into three and that a single daily dose was as effective and no more toxic, with cure rates of around 89% in both groups after 45 days of follow up.21 The alternative therapies are itraconazole, 200-600 mg daily and terbinafine, 250 mg daily. Itraconazole given for up to 36 months is recommended in a guideline for cutaneous sporotrichosis by the American Infectious Disease Society.22 The efficacy of itraconazole is mainly supported by open studies18,19 and there are fewer studies of terbinafine.11 One study of fluconazole, 200-800 mg daily,20 produced a cure in 10 of 14 patients (71%) with lymphocutaneous sporotrichosis.

Other proposed methods of treatment include liquid nitrogen as cryotherapy.23 I have been unable to find any systematic reviews of treatment and there are no controlled clinical studies of oral antifungal agents.

specific side-effects such as sickness, vomiting, hypersalivation and salivary gland swelling. These side-effects are common (affecting around half of the trial participants in the one comparative study described above21) and usually mild.

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