Treatment of sporotrichosis with itraconazole. NIAID Mycoses Study Group.
OBJECTIVE
To describe the clinical presentation and outcomes of treatment with itraconazole in patients with sporotrichosis.


METHODS
A culture for Sporothrix schenckii or compatible histopathology was required for inclusion in the study. Patients with both cutaneous and systemic sporotrichosis were treated. Patients received from 100 to 600 mg of itraconazole daily for 3 to 18 months. Patients were classified as responders or nonresponders. Responders were further classified as remaining on treatment, relapsed, or free of disease. Nonresponders included patients who failed to respond or progressed during treatment with itraconazole.


RESULTS
Twenty-seven patients (mean age: 53 years) were treated with 30 courses of itraconazole. Diabetes mellitus and alcoholism were present in eight and seven patients, respectively. Sites of involvement included lymphocutaneous alone in 9 patients, articular/osseous in 15 (multifocal in 3), and lung in 3. Prior therapy was unsuccessful in 11 patients. Among the 30 courses, there were 25 responders and 5 nonresponders. All 5 nonresponders received at least 200 mg daily of itraconazole for durations that ranged from 6 to 18 months. Of the 25 responders, 7 relapsed 1 to 7 months after treatment durations of 6 to 18 months. Of the 7 who relapsed, 2 are responding to a second course. One responder was lost to follow-up after 10 months of treatment with itraconazole. Of the remaining 17 responders, 3 remain on treatment, and 14 are free of disease over follow-up durations of 6 to 42 months (mean: 17.6 months). Itraconazole was well tolerated with few side effects noted.


CONCLUSIONS
These results document the efficacy of itraconazole in the treatment of cutaneous and systemic sporotrichosis.
Audie L. Murphy Memorial Veterans Hospital, San Antonio, Texas.
P K
PK
Sharkey-Mathis
C A
CA
Kauffman
J R
JR
Graybill
D A
DA
Stevens
J S
JS
Hostetler
G
G
Cloud
W E
WE
Dismukes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D017964:Itraconazole; D007654:Ketoconazole / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013174:Sporotrichosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D007654:Ketoconazole