From the Guidelines
The recommended duration of amphotericin B treatment for invasive mucormycosis pneumonia is typically continued until resolution of initially indicative findings on imaging and reconstitution of host immune system. The initial approach involves high-dose liposomal amphotericin B at 5-10 mg/kg/day intravenously 1. Treatment should continue until clinical improvement is observed, radiographic findings stabilize, and negative cultures are obtained. Surgical debridement of infected tissue is often necessary alongside antifungal therapy. After the initial amphotericin B course, patients usually transition to oral posaconazole (300 mg twice daily on day 1, then 300 mg daily) for extended maintenance therapy lasting 6-12 months. Regular monitoring of renal function, electrolytes, and drug levels is essential during amphotericin B treatment due to its nephrotoxicity.
Key Considerations
- Treatment duration must be individualized based on the extent of infection, immune status, and clinical response.
- Mucormycosis is an aggressive fungal infection with high mortality, particularly in immunocompromised patients, so aggressive and prolonged antifungal therapy is necessary to improve outcomes.
- The optimal daily dose as well as the length of treatment have still to be defined, but starting dosages of 5-7.5 mg/kg/day for L-AMB are commonly used for adults and children 1.
Treatment Approach
- Liposomal amphotericin B is the drug of choice for treating mucormycosis 1.
- In case of renal failure, posaconazole or isavuconazole were shown to be effective alternatives 1.
- If a patient is intolerant to liposomal amphotericin B, its dose can be reduced, but should stay ≥5 mg/kg bodyweight 1.
From the Research
Duration of Treatment with Amphotericin B for Invasive Mucormycosis Pneumonia
- The duration of antifungal chemotherapy with Amphotericin B for invasive mucormycosis pneumonia is not strictly defined, but it is guided by the resolution of all associated symptoms and findings, usually lasting around 6-8 weeks 2.
- In one study, Amphotericin B colloidal dispersion was given at a mean dose of 4.8 mg/kg per infusion for a mean duration of 37 days 3.
- Another study reported that Amphotericin B treatment was changed to Amphotericin B colloidal dispersion (1×400mg/day) and the patient remained in complete remission for more than 1 year 4.
- The treatment duration may vary depending on the patient's response to therapy, the severity of the infection, and the presence of underlying conditions.
- It is essential to note that the treatment of invasive mucormycosis pneumonia often involves a combination of antifungal therapy, such as Amphotericin B, and surgical debridement of necrotic tissues 2, 4, 3.