Medication Summary

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.

Class Summary

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

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 (AmBisome)

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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 (Abelcet)

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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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Media Gallery

Black eschar on the skin of an immunocompromised patient.
Mucormycosis with broad, aseptate hyphae (hematoxylin and eosin, original magnification ×40).
Angioinvasion (hematoxylin and eosin, original magnification ×10).
Perineural invasion (hematoxylin and eosin, original magnification ×20).

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Author

Meera Varman, MD Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer, Sanofi<br/>Received research grant from: Merck; MedImmune; Regenron; Pfizer;Novartis; Sanof; GSK<br/>Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Mary Carmen Y Mancao, MD, Christine A Reyes, MD, and Debra Whaley, MD, to the development and writing of the source article.