From the Guidelines

Mucormycosis diagnosis and treatment in pediatric patients should be initiated promptly with amphotericin B and consideration of surgery.

The Infectious Diseases Society of America guidelines recommend amphotericin B lipid complex and liposomal amphotericin B as first-line treatments for mucormycosis in pediatric patients, including neonates, children, and adolescents 1.
Liposomal amphotericin B is the preferred drug for infections involving the central nervous system due to pharmacokinetic and pharmacodynamic reasons 1.
Posaconazole and the combination of lipid-amphotericin B plus caspofungin are only recommended with marginal strength for first-line therapy in pediatric patients due to limited clinical efficacy data in adults 1.

Salvage therapy options for mucormycosis in children ≥2 years and adolescents include posaconazole, based on adult efficacy data and limited pediatric pharmacokinetic and safety data 1.
Other options for salvage therapy include the combination of lipid amphotericin B plus caspofungin, both of which are approved for all age groups, and the combination of lipid amphotericin B plus posaconazole for children ≥2 years of age 1.

In patients with neutropenia, granulocyte colony-stimulating factor is strongly recommended to shorten neutropenia, a key predisposing factor for mucormycosis 1.
Surgery combined with antifungal therapy is a factor associated with survival in pediatric patients with mucormycosis 1.

From the Research

The diagnosis of mucormycosis requires a high index of suspicion and evaluation with histopathology, culture, and molecular identification 2.
Histopathology and culture are the primary methods for diagnosing mucormycosis, with blood tests having limited diagnostic value 3.
Molecular methods, such as polymerase chain reaction (PCR), are increasingly being used to aid in the diagnosis of mucormycosis 3, 4.

Surgical debridement and antifungal therapies are the cornerstone for combatting invasive mucormycosis 2.
Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, with newer triazoles, such as posaconazole and isavuconazole, potentially effective in patients refractory to or intolerant of LFAB 3, 5.
Early surgical debridement or excision plays an important adjunctive role in the treatment of mucormycosis 3, 4.
Reverting the underlying risk factor for infection is also important for treatment response 5.

The Infectious Diseases Society of America recommends prompt recognition of clinical symptoms and radiographic features of mucormycosis to establish timely diagnosis and initiate targeted therapy 6.
Treatment should be multidisciplinary, involving early surgical intervention, antifungal therapy, and correction of underlying immune compromising risk factors when possible 6.
The severity and relative rarity of mucormycosis make comparative clinical trials for evaluating antifungal therapies in children difficult to conduct, and therapeutic decisions are often derived from retrospective case series, in vitro data, and animal models 2.