Treatment of Mucormycosis

First-Line Antifungal Therapy

The American College of Physicians recommends liposomal amphotericin B (L-AmB) at 5-10 mg/kg/day as the first-line treatment for all forms of mucormycosis, with a strength of evidence of AII 1, 2
The full daily dose of L-AmB should be administered from the first treatment day, rather than slowly increasing over several days, as recommended by the Infectious Diseases Society of America 1
For CNS involvement, L-AmB at 10 mg/kg/day is recommended based on clinical evidence from the European Society of Clinical Microbiology and Infectious Diseases 1, 2
Amphotericin B lipid complex (ABLC) at 5 mg/kg/day can be used as an alternative for patients without CNS involvement, as suggested by the Haematologica journal 1, 3

Surgical debridement or resection should be combined with antifungal therapy whenever possible, as recommended by the American College of Surgeons 1, 3
Surgery is strongly recommended (AII evidence) for rhino-orbito-cerebral mucormycosis, soft tissue infections, and localized pulmonary lesions, according to the Infectious Diseases Society of America 1, 3

Control of underlying conditions is critical (AII evidence) and must be addressed alongside antifungal therapy, as emphasized by the European Society of Clinical Microbiology and Infectious Diseases 1, 3
Rapid correction of metabolic abnormalities is mandatory in uncontrolled diabetes, as recommended by the American Diabetes Association 1, 3
Corticosteroids should be discontinued if feasible, and other immunosuppressive drugs should be tapered, as suggested by the Haematologica journal 1, 3

Posaconazole 400 mg twice daily is recommended for second-line treatment (BII evidence) by the Infectious Diseases Society of America 3
Combination therapy options include lipid amphotericin B plus caspofungin (BII evidence) and lipid amphotericin B plus posaconazole (CIII evidence), as recommended by the European Society of Clinical Microbiology and Infectious Diseases 1, 3
Combination with deferasirox is NOT recommended (AI evidence) by the American College of Physicians 1, 3

Treatment should continue until clinical and radiological resolution of infection, as recommended by the Infectious Diseases Society of America 2
Maintenance therapy with posaconazole is recommended after initial treatment (BIII evidence) by the Haematologica journal 1, 3

Amphotericin B has shown excellent activity against Mucorales in vitro, with most strains displaying MICs near the suggested breakpoint of ≤1 mg/mL, as reported by the Haematologica journal 3, 4
In a review of 120 mucormycosis cases in patients with hematological malignancies, the survival rate was 67% in patients treated with L-AmB compared with 39% in those treated with amphotericin B deoxycholate (P=0.02), as published in the Haematologica journal 4, 5