What is the treatment for mucormycosis?

From the Guidelines

The treatment of mucormycosis requires an aggressive multifaceted approach combining surgical debridement, antifungal therapy, and management of underlying conditions, with high-dose liposomal amphotericin B as the first-line treatment, typically administered at 5-10 mg/kg/day intravenously, as recommended by the most recent guidelines 1.

Key Considerations

• Surgical debridement is essential and should be performed promptly to remove all infected and necrotic tissue, as it has been associated with a decrease in mortality rates 1.
• For antifungal therapy, liposomal amphotericin B is the preferred treatment, with a dosage of 1-1.5 mg/kg/day in 5% dextrose, and an infusion rate of 0.08 mg/kg/hour over 6-8 hours, with a minimum treatment duration of 4-6 weeks 1.
• In cases of CNS involvement, the dosage of liposomal amphotericin B should be increased to 10 mg/kg/day, with careful monitoring of renal function and infusion of normal saline before and after infusion to avoid nephrotoxicity 1.
• Step-down therapy with posaconazole (300 mg twice daily on day 1, then 300 mg daily) or isavuconazole (200 mg every 8 hours for 6 doses, then 200 mg daily) can be considered for patients who cannot tolerate amphotericin B or require long-term treatment 1.

Management of Underlying Conditions

• Control of underlying conditions such as diabetic ketoacidosis, immunosuppression, or other predisposing factors is crucial for successful treatment, as these conditions can increase the risk of mucormycosis and worsen outcomes 1.
• Limiting the use of corticosteroids is also recommended, as they can increase the risk of mucormycosis and worsen outcomes 1.

Monitoring and Follow-up

• Close monitoring of patients with mucormycosis is essential, with regular assessment of clinical and radiological response to treatment, as well as monitoring of renal function and other potential side effects of antifungal therapy 1.
• Treatment should be continued for a minimum of 4-6 weeks, with step-down therapy considered for an additional 3-6 months, as clinical and radiological resolution of symptoms is achieved 1.

From the FDA Drug Label

1.2 Invasive Mucormycosis CRESEMBA is indicated for the treatment of invasive mucormycosis as follows: CRESEMBA for injection: adults and pediatric patients 1 year of age and older CRESEMBA capsules: adults and pediatric patients 6 years of age and older who weigh 16 kg and greater

The treatment for mucormycosis is CRESEMBA (isavuconazonium sulfate), which can be administered via injection or orally in capsule form, depending on the patient's age and weight. The recommended dosage and administration are described in the drug label 2.

From the Research

Treatment Options for Mucormycosis

The treatment for mucormycosis typically involves a combination of surgical intervention and antifungal therapy. The specific approach may vary depending on the severity and location of the infection.

• Surgical debridement of infected tissue is often necessary to control the infection, particularly in cases of rhinocerebral or cutaneous mucormycosis 3, 4, 5.
• Antifungal therapy is also a crucial component of treatment, with lipid formulations of amphotericin B being the standard treatment due to their efficiency 4, 5, 6.
• Posaconazole may be used as an alternative or in combination with other antifungal agents, particularly in cases where surgery is not possible or as a salvage therapy 3, 7, 5, 6.
• Other treatment approaches, such as hyperbaric oxygen and cytokine therapy, may be used as adjunctive therapy in some cases 6.
• The duration of antifungal chemotherapy is typically guided by the resolution of symptoms and findings, usually lasting around 6-8 weeks 5.

Antifungal Agents Used in Treatment

Several antifungal agents are used in the treatment of mucormycosis, including:

• Lipid formulations of amphotericin B, which are considered the first-line treatment 4, 5, 6.
• Posaconazole, which may be used as an alternative or in combination with other antifungal agents 3, 7, 5, 6.
• Isavuconazole, which is also considered a first-line treatment option 6.
• Deferasirox, which may be used as a salvage therapy in some cases 6.

Importance of Prompt Treatment

Prompt and aggressive treatment is essential in controlling mucormycosis, as delaying treatment can significantly decline the chances of survival 6. Reversal of underlying conditions, such as immunocompromised states, is also crucial in managing the infection 5.