Pediatric Mucormycosis Medication
- Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD more...
The drug of choice for the treatment of mucormycosis is amphotericin B. Posaconazole has been rarely used in combination with amphotericin B as a salvage therapy in severe cases of mucormycosis in adults and children.
High doses of this drug are required, and nephrotoxicity may result. Lipid formulations of amphotericin B allow for very high doses to be administered while better protecting renal function. Whether lipid formulations of amphotericin B provide better therapeutic outcomes is not clear, and the high cost necessitates careful consideration of use.
Renal impairment and failed treatment with conventional amphotericin B are appropriate indications for the use of the lipid formulations. Lipid preparations of amphotericin B are used at 5 mg/kg/d. Some have doses of up to 15 mg/kg/d to treat mucormycosis.
High-dose liposomal amphotericin B has been used to treat disseminated disease. Azoles (eg, fluconazole, itraconazole) are not helpful in the treatment of mucormycosis.
Amphotericin B is produced by Streptomyces nodosus. The mechanism of action of this agent is the binding of sterols in fungal cytoplasmic membrane, resulting in membrane permeability that impairs survival of the fungus. This leads to loss of intracellular potassium. Amphotericin B is administered intravenously (IV) when used to treat mucormycosis.
Liposomal amphotericin B is amphotericin B encapsulated in a bilayer of liposomes. This is the antifungal agent of second choice when renal toxicity develops or conventional amphotericin B therapy is failing. Nephrotoxicity and infusion-related toxicity are reduced compared with conventional amphotericin B.
Amphotericin B lipid complex is amphotericin B in phospholipid complexed form. This is the drug of third choice when conventional amphotericin B therapy is failing, but renal function is not impaired.
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