Treatment of Pulmonary Mucormycosis with Liposomal Amphotericin B

Dosing Recommendations

The American College of Physicians and other medical societies recommend liposomal amphotericin B at a dose of 5-10 mg/kg/day as first-line treatment for pulmonary mucormycosis, with strong evidence supporting its use 1, 2, 3
The Infectious Diseases Society of America recommends a minimum dose of 5 mg/kg/day, with doses ranging from 5-10 mg/kg/day depending on disease severity, with moderate to strong evidence 1, 2, 3
The full daily dose should be given from the first treatment day rather than slowly increasing over several days, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 2

Multiple guidelines, including those from the Infectious Diseases Society of America and the European Society of Clinical Microbiology and Infectious Diseases, consistently recommend a minimum dose of 5 mg/kg/day for pulmonary mucormycosis, with moderate to strong evidence 1, 4, 5
Case series have shown that recipients of increased doses (up to 10 mg/kg/day) tended to have increased response rates, with moderate evidence 2, 3

Patients receiving 10 mg/kg/day may experience substantial serum creatinine increases, though these are mostly reversible, as reported by the National Institutes of Health 2, 3
If substantial renal toxicity develops, the dose can be reduced, but doses below 5 mg/kg/day are only marginally recommended by the American College of Physicians 2

Treatment should be initiated immediately upon suspicion of mucormycosis in immunocompromised patients, as recommended by the Infectious Diseases Society of America 2, 3
Surgical resection or debridement should be combined with antifungal therapy whenever possible, with strong evidence from the European Society of Clinical Microbiology and Infectious Diseases 4, 5
The optimal length of treatment has not been clearly defined but typically continues until clinical and radiological resolution of infection, as recommended by the National Institutes of Health 2, 3

Amphotericin B lipid complex (ABLC) at 5 mg/kg/day can be considered for patients without CNS involvement, with moderate strength of recommendation from the Infectious Diseases Society of America 2, 3
Conventional amphotericin B deoxycholate is discouraged due to its substantial toxicity, especially at the doses needed for mucormycosis, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 2, 3, 4

Limited data support combinations of L-AmB with azoles or echinocandins, with weak evidence from the National Institutes of Health 2, 3
Clinical evidence for combination therapy remains limited and is only marginally recommended by the Infectious Diseases Society of America 2, 3

In patients with renal impairment, L-AmB is preferred over conventional amphotericin B formulations, as recommended by the American College of Physicians and the National Institutes of Health 2, 4
For patients who cannot tolerate or have contraindications to L-AmB, isavuconazole can be considered as an alternative first-line treatment with moderate strength of recommendation from the Infectious Diseases Society of America 2, 3