Zygomycosis is a difficult to treat and frequently fatal
infection affecting immunocompromised and, rarely, immunocompetent patients. The early diagnosis and immediate initiation of treatment with an
antifungal agent in combination with surgical intervention has proved critical for the favourable outcome of the disease. Few
antifungal agents are available for treatment.
Amphotericin B (AmB)
deoxycholate has been the
drug of choice for many years and is usually given at high daily doses which can result in renal toxicity. Currently,
lipid formulations of AmB (liposomal AmB (
L-AmB), AmB
lipid complex (ABLC), AmB colloidal dispersion (ABCD)), mainly
L-AmB, rather than conventional AmB have become the standard
therapy. The rationale behind the use of
lipid formulations is that they decrease the nephrotoxicity associated with longterm AmB use. Although there is a developing consensus that high doses of
lipid formulations of AmB should be the antifungal
therapy of choice for all patients with
zygomycosis, until now there have been no data available with which to define the appropriate dose. The
duration of therapy remains an unresolved issue, regarding both
lipid formulations of AmB as well as sequential or combination treatments consisting of
lipid formulations of AmB with
posaconazole, a
drug which has now emerged as a new therapeutic option.