What is the role of antifungal therapy in the treatment of mucormycosis (zygomycosis)?

Updated: Jul 06, 2021
  • Author: Avnish Sandhu, DO; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

No prospective comparative studies of the primary treatment of mucormycosis have been performed, largely because of the rarity of this disease. In current practice, amphotericin B and isavuconazole are the 2 antifungal agents licensed by the US Food and Drug Administration (FDA) for the primary therapy of mucormycosis. First-line treatment is with an amphotericin derivative, preferably the liposomal form of amphotericin B to minimize nephrotoxicity. Other options include amphotericin B deoxycholate, isavuconazole, and posaconazole. In patients with extensive disease or rapid progression, the addition of posaconazole or isavuconazole to amphotericin B may be considered  [77, 78, 39] ; definitive data are not available.

Although some reports have described a combination of different classes of antifungal agents, trials are needed to determine the efficacy of this approach. [79]  Potential advantages would include more rapid fungicidal activity and lower risk of resistance. Potential disadvantages would include the risk for antagonism, additive or synergistic toxicity, more drug-drug interactions, and higher cost. [80]

 


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