Home > Treatment Recommendations > Fungal Infections > Mucormycosis

Mucormycosis

[Lancet Infect Dis 2019;19:e405-21, Medical Mycology 2018;56:S93-101]

Usual Pathogens

Rhizopus spp

Mucor spp

Lichtheimia spp (formerly Absidia and Mycocladus spp)

Rhizomucor spp

Cunninghamella spp

Apophysomyces spp

Saksenaea sp

Clinical manifestations:

- In immunocompromised patients (especially with febrile neutropenia and GVHD), main route of infection is by inhalation of sporangiospores causing pulmonary infections.

- Diabetics tend to get rhino-orbital disease.

- Immunocompetent patients - skin and soft tissue infections, typically following traumatic injuries.

- Combination therapy with amphotericin B formulations and isavuconazole or posaconazole or caspofungin has been studied. No advantage in haematological malignancies but may have an advantage in rhino-orbital-cerebral mucormycosis.

- Infectious Diseases consult recommended.

Empiric Therapy	Dose	Duration
Surgical debridement
plus
Amphotericin B, lipid complex or liposomal	5-10mg/kg IV daily	Treat until: resolution of clinical signs and symptoms of infection resolution or stabilization of radiographic abnormalities resolution of underlying immunosuppression (consider secondary prophylaxis)

Empiric Therapy

Dose

Duration

Surgical debridement

plus

Amphotericin B, lipid complex or liposomal

Treat until:

resolution of clinical signs and symptoms of infection
resolution or stabilization of radiographic abnormalities
resolution of underlying immunosuppression (consider secondary prophylaxis)

Central Nervous System (CNS) infection

Empiric Therapy	Dose	Duration
Amphotericin B, liposomal	10mg/kg IV daily	Treat until: resolution of clinical signs and symptoms of infection resolution or stabilization of radiographic abnormalities resolution of underlying immunosuppression (consider secondary prophylaxis)
Alternative/Oral switch therapy
Isavuconazole	200mg IV/PO tid x 6 doses, then 200mg IV/PO daily	Treat until: resolution of clinical signs and symptoms of infection resolution or stabilization of radiographic abnormalities resolution of underlying immunosuppression (consider secondary prophylaxis)
or
Posaconazole	300mg IV/DR tab PO bid x 2 doses, then 300mg IV/DR tab PO daily	Treat until: resolution of clinical signs and symptoms of infection resolution or stabilization of radiographic abnormalities resolution of underlying immunosuppression (consider secondary prophylaxis)