Management of Mucormycosis

Abstract

Mucormycosis is an aggressive disease with high (> 30–50%) mortality. Many attempts have been made to improve the outcome including global consensus guideline to manage mucormycosis. In this review, we discuss various aspects of the current management strategies of mucormycosis. New global consensus guideline not only addressed the management issues in developed countries but also recommended algorithm in a resource-limiting environment. Isavuconazole, a new water-soluble triazole with good pharmacokinetics and safety profile, has emerged as a promising agent with anti-Mucorales activity. The drug can be used even as first-line therapy with a moderate recommendation. New antifungal agents including Manogepix (MGX), VT-1161, and statins with anti-Mucorales activity are undergoing clinical trials. Different routes of antifungal administration for targeted delivery are being explored, viz., nebulization, topical treatment, intravitreal route. Early diagnosis and prompt therapy remain the cornerstone of mucormycosis management. Few recent studies reemphasized the need for combined management with surgical debridement of necrotic tissue, antifungal therapy, and reversal of underlying disease for a better outcome. New drug isavuconazole covers some of the gaps in management of patients with renal and hepatic compromise. Combination antifungal therapy remains controversial and requires prospective randomized studies. Adjuvant therapies are also not supported strongly due to the lack of clinical trials. The low incidence of the disease in developed countries is the main barrier for randomized studies. However, the disease is not uncommon in developing countries. Planning prospective, multi-center studies in those countries may help to standardize the dosage and duration of antifungals for therapeutic or prophylactic use in mono/combination therapy. Simultaneous maintenance of national/regional clinical registries and the discovery of novel therapeutic targets and diagnostic biomarkers are essential for aiding disease management. Additional studies on therapeutic drug monitoring, antifungal susceptibility testing, and correlation with the clinical outcome are needed to establish clinical breakpoints which can help in guiding therapy.