What is the treatment for mucormycosis?

From the Guidelines

The treatment of mucormycosis should involve prompt surgical debridement and antifungal therapy with liposomal amphotericin B as the drug of choice, at a dose of ≥5 mg/kg bodyweight, as recommended by the global guideline for the diagnosis and management of mucormycosis 1. The goal of treatment is to improve morbidity, mortality, and quality of life outcomes by aggressively managing the infection.

• Key components of treatment include:
  • Surgical debridement to remove infected and necrotic tissue
  • Antifungal therapy with liposomal amphotericin B
  • Management of underlying conditions, such as diabetic ketoacidosis and immunosuppression
• In cases where liposomal amphotericin B is not tolerated, posaconazole or isavuconazole can be considered as alternative treatments, as shown in studies 1.
• The duration of therapy should be continued until resolution of initially indicative findings on imaging and reconstitution of host immune system, with isavuconazole or posaconazole potentially used as maintenance therapy 1.
• It is essential to note that treatment should be initiated promptly, even before confirmation of mucormycosis, due to the rapidly progressive nature of the infection.
• Controlling underlying conditions and correcting metabolic abnormalities are crucial components of treatment, as they can significantly impact patient outcomes.
• Adjunctive therapies, such as hyperbaric oxygen, may be considered in selected cases, although the evidence for their use is limited.

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...

The treatment for mucormycosis is amphotericin B (IV), specifically for infections due to susceptible species of the genera Absidia, Mucor, and Rhizopus, and related susceptible species of Conidiobolus and Basidiobolus 2.

From the Research

Treatment Options for Mucormycosis

• The mainstay treatment strategies for mucormycosis include surgical debridement in combination with systemically active antifungal drugs 3.
• Lipid-based amphotericin B is the treatment of choice for first-line therapy, while posaconazole may be a promising alternative 3.
• Isavuconazole constitutes an option for the treatment of mucormycosis refractory to liposomal amphotericin B 4.
• The first-line chemotherapy of mucormycosis includes high-dose liposomal amphotericin B (≥ 5 mg/kg/day) 5.
• Amphotericin B and isavuconazole are the drugs of choice for first-line therapy in the treatment of mucormycosis 6.
• Salvage therapy with posaconazole and deferasirox is another approach for patients who are not responsive to any other therapy 6.
• Adjunctive therapy, which involves hyperbaric oxygen and cytokine therapy, is also used in the treatment of mucormycosis along with first-line therapy 6.

Surgical Intervention

• Prompt and aggressive surgery is a cornerstone of mucormycosis treatment, achieved by extensive surgical debridement of necrotic tissues 5.
• Surgical excision of affected tissue is crucial in the treatment of mucormycosis, as seen in a case report where a patient was successfully treated with a combination of antifungal therapy, surgical excision, and reversal of the underlying immunocompromised state 7.

Combination Therapy

• Combination therapy, including antifungal therapy and surgical intervention, is essential for the successful treatment of mucormycosis 7, 6.
• The choice of antifungal treatment depends on several factors, including the safety profile of the drug, its spectrum of activity, and the species of fungus causing the infection 7.