From the Guidelines
The recommended dosage of liposomal amphotericin B for the treatment of mucormycosis is 5 mg/kg/day, with 10 mg/kg/day recommended for those with CNS involvement, as stated in the most recent guidelines 1. The treatment of mucormycosis requires prompt initiation of antifungals after diagnosis, and surgical intervention should not be delayed for patients who need debridement.
- The first-line therapy for mucormycosis is liposomal amphotericin B, due to its better safety profile compared to conventional amphotericin B deoxycholate.
- Conventional amphotericin B deoxycholate may be used as an alternative, but it carries higher risks of nephrotoxicity and infusion reactions, with a recommended dosage of 1-1.5 mg/kg/day.
- Treatment duration typically ranges from 4-6 weeks, depending on clinical response and resolution of infected tissues.
- During therapy, patients require close monitoring of renal function, electrolytes, and complete blood counts.
- Premedication with acetaminophen and diphenhydramine can help manage infusion-related reactions.
- Surgical debridement of necrotic tissue is an essential adjunct to antifungal therapy, as mucormycosis often causes tissue infarction that limits drug penetration, as supported by previous guidelines 1. The high dosage is necessary because Mucorales fungi are relatively resistant to antifungal agents, and adequate tissue concentrations are needed to inhibit fungal growth in poorly perfused, necrotic tissues.
- The treatment of mucormycosis should be continued until both clinical and radiological resolution occurs, and should be tailored to each patient based on their underlying immune status, as recommended in the latest guidelines 1.
From the FDA Drug Label
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 dosage of Amphotericin B for the treatment of mucormycosis (rhinocerebral phycomycosis) is a cumulative dose of at least 3 g. The daily dosage may range from 0.25 mg/kg to 1.5 mg/kg per day, depending on the patient's clinical status and cardio-renal function 2.
From the Research
Dosage of Amphotericin B for Mucormycosis Treatment
- The dosage of Amphotericin B for the treatment of mucormycosis varies depending on the formulation and the patient's condition.
- A study from 2001 3 reported a mean dose of 4.8 mg/kg per infusion of amphotericin B colloidal dispersion (ABCD) for a mean duration of 37 days.
- A review from 2020 4 recommends the use of liposomal amphotericin B at a dose of ≥5mg/kg combined with surgery as first-line therapy for mucormycosis.
- Another study from 2003 5 reported a dose of 3 mg/kg/d of liposomal amphotericin B, with a total dose of 5.6 gram over 29 days.
Formulations of Amphotericin B
- Different formulations of amphotericin B, such as liposomal amphotericin B and amphotericin B colloidal dispersion (ABCD), have been used to treat mucormycosis.
- Liposomal amphotericin B is recommended as first-line therapy due to its reduced nephrotoxicity compared to conventional amphotericin B 4.
- ABCD has also been shown to be effective in treating mucormycosis, with a response rate of 60% in one study 3.
Combination Therapy
- Combination therapy with surgery and amphotericin B is often used to treat mucormycosis.
- A study from 2001 3 reported similar response rates when patients were treated with ABCD alone or in combination with surgery.
- The review from 2020 4 recommends combination therapy with liposomal amphotericin B and surgery as first-line therapy for mucormycosis.