What is the role of posaconazole 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

Posaconazole, another triazole antifungal, has been shown to be superior to fluconazole or itraconazole as prophylaxis against invasive mold infection (both aspergillosis and mucormycosis) in patients with hematologic malignancy who have neutropenia or GVHD. The number needed to treat (NNT) to prevent one fungal infection was 27 and to prevent one death was 35. [91]

Posaconazole can be used for off-label salvage treatment of mucormycosis in patients intolerant to amphotericin B. Issues with the absorption of the oral suspension of posaconazole, particularly decreased absorption in the setting of proton pump inhibitor (PPI) or antimotility agent (eg, metoclopramide) use have been overcome with the introduction of a delayed-release tablet formulation. [81, 75]  An intravenous formulation is also available. Therapeutic drug monitoring is strongly recommended for patients on posaconazole being treated for mucormycosis. [39]

Several case reports have discussed the use of posaconazole, [73, 92]  including as salvage therapy. [93]  A review of 96 patients treated with posaconazole found that complete response was achieved in 62 (64.6%), partial response in 7 (7.3%) patients, and stable disease in 1 (1%), with an overall mortality of 24%. [77]  Rickerts et al reported that liposomal amphotericin B plus posaconazole was successful in the treatment of disseminated mucormycosis in a patient who could not undergo surgery; however, the benefit of dual antifungal therapy is unclear. [79, 94]

Posaconazole has also been used as step-down therapy after the initial administration and control of the disease with liposomal amphotericin B. [95, 96]

 


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