Which adjunctive therapies are used 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

Hyperbaric oxygen therapy after surgical debridement has been used, especially in cases of cutaneous disease and rhinocerebral disease in diabetics, but its effectiveness has not been extensively studied. Treatment of mucormycosis is not one of the approved uses of hyperbaric oxygen. [92, 107]  High oxygen concentrations may improve neutrophil function, inhibit the growth of Mucorales, and improve wound healing.

Colony-stimulating factors have been used to enhance immune responses, specifically in neutropenic patients, as have interferon-gamma and white blood cell transfusions. The usefulness of these interventions is unclear.

Finally, the use of iron chelators without xenosiderophore activity (eg, deferasirox) has been described in case reports. [107]  Older iron chelators, namely deferoxamine, can be exploited as an iron source by Rhizopus, thereby increasing the risk for mucormycosis. [75]  Newer agents such as deferasirox were hypothesized to decrease the risk of mucormycosis via iron starvation; however, they have not proven clinically efficacious. [108]  In an immunosuppressed murine model of pulmonary mucormycosis, a combination of deferasirox with posaconazole increased the AUC/MIC of posaconazole but failed to demonstrate improved efficacy over monotherapy. [109]  In the DEFEAT MUCOR study, 20 patients with mucormycosis were randomly assigned to L-AmB plus deferasirox or L-AmB plus placebo; the deferasirox arm had a higher 90-day mortality rate. [110, 111]

 


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