What is the role of combination 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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Most Mucorales species show moderate in vitro resistance to the echinocandins; these agents cannot be used in the treatment of mucormycosis. [29]  Animal and limited clinical data have suggested that combination therapy with amphotericin and an echinocandin may improve survival. [81, 82, 100, 101, 102]  However, a recent retrospective cohort study of combination liposomal amphotericin B (L-AmB) with posaconazole, L-AmB with echinocandins, and posaconazole with echinocandins showed no differences in mortality between monotherapy and combination treatment groups. [103]  The in vitro combinations of isavuconazole with micafungin or amphotericin resulted in a range of interactions, some concentration-dependent, ranging from antagonism to synergy against various Mucorales. [104]

Further clinical trials are needed before antifungal combination therapy can be definitively recommended. Currently there is a clinical trial assessing the combination of inhaled amphotericin +IV liposomal amphotericin B vs IV amphotericin alone, and other novel therapies are being evaluated out based on medical patent review and in-vitro data. [105, 106]

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