What is the role of amphotericin B 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

Amphotericin B has proven efficacy in the treatment of mucormycosis. The liposomal formulation (AmBisome) is the drug of choice based on efficacy and safety data. [81, 82, 83, 39]  ECMM recommends a  dosage of  5-10 mg/kg of liposomal amphotericin B; the dose need not be slowly increased; instead, a full dose should be given on day 1 of treatment. [39]  High doses of liposomal amphotericin B ≥ 7.5 mg/kg were tested in a pilot study (Ambizygo); the response rate was 43% among patients who received the higher dose during the first week compared with 0% in patients who did not. [84]  A high dose combined with surgery led to an overall response rate of 36% and 45% at week 4 and 12 respectively. [84]  A higher dose of 10mg/kg is recommended in patients with CNS involvement. [39]

The use of higher doses, however, has been associated with rates of nephrotoxicity up to 40% without a concomitant mortality benefit. [72, 79, 85, 84]

Amphotericin B deoxycholate can also be used to treat mucormycosis, particularly when other formulations prove too costly. The typical dose is 1-1.5 mg/kg/d. The total dose given over the course of therapy is usually 2.5-3 g. High doses of this drug are required, and nephrotoxicity may result. This is of particular concern because many patients who develop mucormycosis have preexisting renal disease (eg, diabetics, transplant recipients). Monitoring the renal function of patients taking amphotericin B is critical; doubling of serum creatinine over the baseline levels is an indication for changing to liposomal amphotericin B.

In addition, careful monitoring and repletion of serum electrolytes (eg, potassium, phosphorus, magnesium) should be performed when administering any formulation of amphotericin B.


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