Posaconazole for Mucormycosis

Role and Positioning

• The European Society of Clinical Microbiology and Infectious Diseases strongly recommends posaconazole as salvage therapy for mucormycosis at a dose of 400 mg twice daily, not as first-line treatment, with liposomal amphotericin B remaining the first-line agent 1, 3

Dosing Protocol

• The standard dose of posaconazole for salvage therapy is 400 mg twice daily using the delayed-release tablet formulation, with a target trough serum concentration of 0.7-1.0 μg/mL 4, 5, 6

Clinical Efficacy Data

• Complete/partial response rates with posaconazole salvage therapy are 60-80% in patients with refractory disease or intolerance to amphotericin B, with a survival rate of 72% in the ECMM registry of mucormycosis patients receiving posaconazole 4

Specific Clinical Scenarios

• Posaconazole is recommended for salvage therapy in children ≥2 years and adolescents, based on adult efficacy data and limited pediatric pharmacokinetic/safety data, but not recommended with strong evidence for first-line pediatric therapy due to lack of clinical efficacy data 5, 6
• The European Society of Clinical Microbiology and Infectious Diseases recommends lipid amphotericin B plus posaconazole with CIII evidence, a weak recommendation, for combination therapy 7

Essential Adjunctive Measures

• Surgery combined with medical treatment is strongly recommended, with AII evidence, whenever feasible, and immediate treatment initiation and reversal of predisposing conditions are critical for survival 1, 3, 8

Treatment Duration

• Posaconazole treatment should continue until complete clinical and radiological resolution of infection and permanent reversal of predisposing factors, with no specific duration defined 1, 3