Recommended Dose of Liposomal Amphotericin B for Pulmonary Mucormycosis

For pulmonary mucormycosis, liposomal amphotericin B should be administered at a dose of 5-10 mg/kg/day as first-line treatment. 1

Dosing Recommendations

Liposomal amphotericin B (L-AmB) is the drug of choice for treating pulmonary mucormycosis with strong evidence supporting its use 1
The recommended dose should be at least 5 mg/kg/day, with doses ranging from 5-10 mg/kg/day depending on disease severity 1
The full daily dose should be given from the first treatment day rather than slowly increasing over several days 1
For pulmonary mucormycosis without CNS involvement, 5 mg/kg/day may be sufficient 1
Higher doses (10 mg/kg/day) should be considered for severe infections or when there is CNS involvement 1

Multiple guidelines consistently recommend a minimum dose of 5 mg/kg/day for pulmonary mucormycosis 1
Case series have shown that recipients of increased doses (up to 10 mg/kg/day) tended to have increased response rates 1
A prospective pilot study using high-dose L-AmB (10 mg/kg/day) for mucormycosis showed an overall response rate of 36% at week 4 and 45% at week 12 2
Doses higher than 10 mg/kg/day have not been shown to result in higher blood concentrations and are not recommended 1

Patients receiving 10 mg/kg/day may experience substantial serum creatinine increases, though these are mostly reversible 1
If substantial renal toxicity develops, the dose can be reduced, but doses below 5 mg/kg/day are only marginally recommended 1
In a prospective study of high-dose L-AmB (10 mg/kg/day), serum creatinine doubled in 40% of patients but returned to normal levels within 12 weeks in 63% of those affected 2

Treatment should be initiated immediately upon suspicion of mucormycosis in immunocompromised patients 1
Surgical resection or debridement should be combined with antifungal therapy whenever possible 1
The optimal length of treatment has not been clearly defined but typically continues until clinical and radiological resolution of infection 1
Treatment delays of 6 or more days from symptom onset have been associated with doubled mortality rates 1

Amphotericin B lipid complex (ABLC) at 5 mg/kg/day can be considered for patients without CNS involvement, with moderate strength of recommendation 1
Conventional amphotericin B deoxycholate is discouraged due to its substantial toxicity, especially at the doses needed for mucormycosis 1

Limited data support combinations of L-AmB with azoles or echinocandins 1
Recent research suggests that combination of L-AmB and isavuconazole may have synergistic effects in experimental models 3
However, clinical evidence for combination therapy remains limited and is only marginally recommended 1

In patients with renal impairment, L-AmB is preferred over conventional amphotericin B formulations 1
For patients who cannot tolerate or have contraindications to L-AmB, isavuconazole can be considered as an alternative first-line treatment with moderate strength of recommendation 1
Adjunctive nebulized amphotericin B has been studied but has not shown significant improvement in treatment outcomes 4, 5