Recent advances in the management of mucormycosis: from bench to bedside.
Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data. Preclinical and limited retrospective clinical data suggest that combination LFAB-echinocandin therapy may improve survival during mucormycosis. A definitive trial is needed to confirm these results. Combination therapy with LFAB and the iron chelator, deferasirox, also improved outcomes in animal models of mucormycosis. In contrast, combination polyene-posaconazole therapy was of no benefit in preclinical studies. Adjunctive therapy with recombinant cytokines, hyperbaric oxygen, and/or granulocyte transfusions can be considered for selected patients. Early initiation of therapy is critical to maximizing outcomes; recent developments in polymerase chain reaction technology are advancing early diagnostic strategies. Prospective, randomized clinical trials are needed to define optimal management strategies for mucormycosis.
Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles Medical Center, 1124 West Carson St., RB2, Torrance, CA 90502, USA. bspellberg@labiomed.org
Brad
B
Spellberg
Thomas J
TJ
Walsh
Dimitrios P
DP
Kontoyiannis
John
J
Edwards
Ashraf S
AS
Ibrahim
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D019090:Case Management; D002986:Clinical Trials as Topic; D000077588:Deferasirox; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy*; D011090:Polyenes / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use
D000935:Antifungal Agents; D001565:Benzoates; D054714:Echinocandins; D007155:Immunologic Factors; D011090:Polyenes; D014230:Triazoles; C068538:liposomal amphotericin B; C101425:posaconazole; D000666:Amphotericin B; D000077588:Deferasirox