What is the recommended dose of lyophilized amphotericin B (Amphotericin B) for a 40-year-old male patient weighing 60 kg with mucormycosis?

Dosing of Liposomal Amphotericin B for Mucormycosis

For a 40-year-old male patient weighing 60 kg with mucormycosis, liposomal amphotericin B should be administered at a dose of 5-10 mg/kg/day (300-600 mg daily), with immediate initiation of the full dose rather than gradual escalation.

First-Line Treatment Recommendations

• Liposomal amphotericin B (L-AmB) is strongly recommended as the first-line treatment for mucormycosis at a dose of 5-10 mg/kg/day 1, 2, 3
• For a 60 kg patient, this translates to 300-600 mg daily, administered intravenously 2
• The full daily dose should be given from the first treatment day rather than slowly increasing over several days 1, 3
• For CNS involvement, the higher end of the dosing range (10 mg/kg/day or 600 mg for this patient) is recommended 1, 3

Dosing Considerations Based on Disease Site

• For pulmonary mucormycosis: 5-10 mg/kg/day (300-600 mg for this patient) 1, 2
• For rhinocerebral mucormycosis: 10 mg/kg/day (600 mg for this patient) is recommended due to the aggressive nature of the disease 4
• For disseminated disease: 5-10 mg/kg/day (300-600 mg for this patient) 1, 2

Treatment Duration

• The optimal duration of treatment has not been clearly defined in clinical trials 2
• Treatment should continue until there is clinical and radiological resolution of infection, typically for at least 6-8 weeks 1, 2
• For rhinocerebral mucormycosis, a cumulative dose of at least 3 g is recommended 4

Monitoring and Toxicity Management

• Monitor renal function regularly as nephrotoxicity is a common side effect, though less severe than with conventional amphotericin B 2, 5
• If substantial renal toxicity develops, the dose can be reduced, but doses below 5 mg/kg/day are only marginally recommended 2, 3
• Monitor serum electrolytes, particularly potassium and magnesium, as electrolyte abnormalities are common 5

Alternative Options

• If liposomal amphotericin B is not available or not tolerated, amphotericin B lipid complex (ABLC) at 5 mg/kg/day can be considered for patients without CNS involvement 1, 3
• Conventional amphotericin B deoxycholate (0.7-1.0 mg/kg/day) could be used but is not preferred due to its substantial toxicity 1
• For patients who cannot tolerate or have contraindications to L-AmB, isavuconazole can be considered as an alternative first-line treatment 1, 3

Important Considerations

• Mucormycosis is a medical emergency requiring immediate treatment initiation 1, 3
• Surgical debridement with clean margins should be performed whenever possible in conjunction with antifungal therapy 1, 3
• Delayed treatment initiation (≥6 days) is associated with a two-fold increase in mortality 3
• Underdosing amphotericin B formulations may lead to treatment failure - ensure adequate dosing from the start 2, 3

Special Situations

• For patients with renal impairment, L-AmB is still preferred over conventional amphotericin B formulations 2, 3
• Control of underlying conditions (such as diabetes, if present) is critical for treatment success 3
• Consider combination therapy with an azole or echinocandin only in refractory cases, as evidence for this approach is limited 2, 3