The pythiosis treatment depends on the animal's immune system and becomes complex, because the agent has its own characteristics, making the action of medicines difficult. Several protocols have been implemented, among the main therapeutic methods used, are surgical, chemical (antifungal), immunotherapy and all of them. This study aimed to perform a literature review, exposing important aspects related to the pythiosis treatment in horses. Amphotericin B specifically communicates with steroids in the fungal cell wall, such as ergosterol, causing porosity in lipid membranes. Potassium iodide can be used efficiently in the treatment of equine pythiosis, as it presents regression of the lesion and favorable evolution of the clinical cases. The use of the combination of different forms of treatment can become a viable alternative. Given the above, surgical removal performed alone does not present satisfactory results, and relapses were observed in 30% of cases and should be associated with other forms of treatment. Treatment with immunotherapy is effective when performed within 60 days of pythiosis evolution.