In recent years, substantial advances have been achieved in the treatment of
mucormycosis. It is now clear that early initiation of
therapy results in substantially better outcomes, underscoring the need to maintain a high index of suspicion and aggressively biopsy potential lesions. Increasing data support the need for surgical excision of infected and/or necrosed tissue whenever feasible. Based on their superior safety and efficacy,
lipid formulations of
amphotericin B have become the standard treatment for
mucormycosis.
Posaconazole may be useful as
salvage therapy, but cannot be recommended as primary
therapy for
mucormycosis based on available data. Pre-clinical and limited retrospective clinical data suggest that combination
therapy with
lipid formulations of
amphotericin and an
echinocandin improves survival during
mucormycosis. A definitive trial is needed to confirm these results. The use of the
iron chelator,
deferasirox, as adjunctive
therapy also improved outcomes in animal models of
mucormycosis. However, its efficacy was not confirmed in a recent, phase 2 clinical trial. Additional study is required of the potential for abrogation of
iron acquisition as adjunctive treatment of
mucormycosis. Combination polyene-
posaconazole therapy was of no benefit in pre-clinical studies. Adjunctive
therapy with recombinant
cytokines, hyperbaric
oxygen, and/or granulocyte transfusions can be considered in selected patients. Large-scale, prospective, randomized clinical trials are needed to define optimal management strategies for
mucormycosis.