Clinical Scenario

Disseminated mucormycosis is a rapidly progressive invasive fungal infection requiring immediate, simultaneous surgical and systemic intervention. Speed of initiation is critical — this protocol addresses first-line management from the outset of diagnosis.

Treatment Approach

The protocol calls for early complete surgical debridement combined with the immediate start of systemic antifungal therapy. A polyene antifungal agent is the strongly recommended first-line systemic choice; azole antifungals represent alternatives for specific clinical presentations. For patients who achieve disease stabilisation, step-down to an oral agent is an option.

Specific agent selection, dosing, route, sequencing, and the full step-down algorithm are not shown here — access the complete regimen below.

Treatment Goals

Success is defined as stable disease or partial response, with resolution of signs and symptoms of infection and substantial radiographical improvement. Weekly imaging is used to assess treatment response throughout the course.

References

The guideline group strongly supports an early complete surgical treatment for mucormycosis whenever possible, in addition to systemic antifungal treatment.
First-line treatment with liposomal amphotericin B 5–10 mg/kg per day is strongly supported across all patterns of organ involvement.
Doses should not be slowly increased over several days; rather, the full daily dose should be given from the first treatment day.
If substantial renal toxicity develops, the dose can be reduced as necessary, but doses below 5 mg/kg per day are recommended with marginal strength only.
Amphotericin B lipid complex 5 mg/kg per day is recommended with moderate strength for patients without CNS involvement.
Isavuconazole is recommended with moderate strength for the first-line treatment of mucormycosis.
The group marginally supports use of posaconazole oral suspension, and moderately supports posaconazole delayed release tablets and infusion for first-line treatment.
Use of amphotericin B deoxycholate is discouraged whenever alternatives are available.
When switching to oral treatment, use of isavuconazole or posaconazole delayed release tablets is strongly supported.
In view of the rapid progress of mucormycosis, weekly CT scans are strongly recommended, particularly in unstable patients.
Therapy can be continued until resolution of signs and symptoms of infection, and substantial radiographical improvement.

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First-Line Treatment of Disseminated Mucormycosis: Surgical and Antifungal Protocol