Treatment Options for Mucormycosis

Abstract

Mucormycosis, which occurs primarily in immunosuppressed patients and patients with diabetes mellitus, remains one of the most difficult fungal infections to treat. In part, this is due to the poor immune response of those patients who have hematological malignancies or have received a hematopoietic cell or solid organ transplant, but also very important is the paucity of available non-toxic effective antifungal agents. Correction of underlying risk factors is helpful, but this is possible mostly in those with diabetes. Surgical debridement of all necrotic tissue is crucially important in decreasing mortality. Lipid formulations of amphotericin B are the treatment of choice. Posaconazole oral suspension has been used successfully in salvage trials and allows long-term therapy that was not possible previously. The new delayed-release tablet achieves higher serum concentrations and should prove to be more efficacious than the suspension in step-down therapy after initial amphotericin B treatment. Isavuconazole is a newly approved azole that appears to be efficacious against mucormycosis in salvage studies. Similar to posaconazole, the oral capsule is available to use as step-down therapy after initial amphotericin B treatment. Both of these azoles are now available as intravenous formulations that perhaps may prove effective as primary therapy for mucormycosis, but until clinical trials have shown that indeed, they are efficacious, these agents should not be considered appropriate for primary therapy of mucormycosis.