From the Guidelines
The treatment for pulmonary zygomycosis should involve a combined approach of surgical debridement and antifungal therapy with liposomal amphotericin B as the primary agent, due to its efficacy in reducing mortality from 62% to 11% when surgery is included 120. Pulmonary zygomycosis, also known as mucormycosis, is a serious fungal infection that requires prompt and aggressive treatment to improve survival rates. The evidence suggests that a multifaceted approach is necessary, including:
- Surgical debridement or resection of infected lung tissue, which has been shown to decrease mortality rates significantly 120
- Antifungal therapy with liposomal amphotericin B, which has been found to be more effective than the deoxycholate formulation in murine models 124
- Management of underlying conditions, such as diabetes, immunosuppression, and metabolic abnormalities The use of liposomal amphotericin B is recommended due to its ability to reach higher lung concentrations and achieve better fungal tissue clearance compared to other formulations 125. The dosage of liposomal amphotericin B should be 5-10 mg/kg/day intravenously, and treatment should be continued for several weeks to months, depending on clinical response. For patients who cannot tolerate or respond poorly to amphotericin B, posaconazole or isavuconazole can be used as alternative treatments 1. Regular monitoring of renal function is necessary during amphotericin B therapy due to its nephrotoxicity. Early intervention is crucial for improving survival chances in pulmonary zygomycosis, and a combined approach of surgical and medical treatment has been shown to result in higher survival rates 3, 121.
From the FDA Drug Label
Amphotericin B for Injection USP is specifically intended to treat potentially life-threatening fungal infections: ... zygomycosis including mucormycosis due to susceptible species of the genera Absidia, Mucor and Rhizopus, and infections due to related susceptible species of Conidiobolus and Basidiobolus... A cumulative dose of at least 3 g of amphotericin B is recommended to treat rhinocerebral phycomycosis Although a total dose of 3 to 4 g will infrequently cause lasting renal impairment, this would seem a reasonable minimum where there is clinical evidence of invasion of deep tissue.
The treatment for pulmonary zygomycosis is amphotericin B (IV). The optimal dose is unknown, but a cumulative dose of at least 3 g is recommended for the treatment of rhinocerebral phycomycosis, which may be applicable to pulmonary phycomycosis. However, the dosage regimen may vary depending on the patient's clinical status and cardio-renal function 2 2.
- Key points:
- Amphotericin B (IV) is the recommended treatment for pulmonary zygomycosis
- Cumulative dose of at least 3 g may be necessary
- Dosage regimen should be individualized based on patient's clinical status and cardio-renal function
From the Research
Treatment for Pulmonary Zygomycosis
The treatment for pulmonary zygomycosis typically involves a combination of antifungal therapy and surgical debridement. The mainstays of treatment are:
- Control or reversal of the underlying disease or immunosuppression
- Antifungal therapy
- Aggressive surgical debridement 3 Some studies suggest that efficient diagnostics, increased physician awareness, and reliance on adjunctive surgical therapy can result in a favorable outcome of pulmonary zygomycosis in immunocompromised children with hematological malignancies 4.
Antifungal Therapy
Antifungal therapy for pulmonary zygomycosis often involves the use of:
- Liposomal amphotericin B (L-AmB) 4, 5, 6, 7
- Posaconazole, a new triazole antifungal, which has been used successfully in a number of cases that did not respond to amphotericin B 3, 6, 7
- Amphotericin B formulations, which have been shown to improve survival in patients with zygomycosis 5
Surgical Debridement
Surgical debridement is a crucial component of the treatment for pulmonary zygomycosis, and has been shown to significantly improve survival in patients with the disease 5, 7. Some key points to note about the treatment of pulmonary zygomycosis include: