Disseminated Mucormycosis in Pre-Existing Renal Failure: What to Do When First-Line Therapy Has Not Worked
This protocol applies to patients with pre-existing renal failure who have disseminated mucormycosis and whose initial antifungal treatment course has not produced the required clinical and radiographic response.
First-Line Treatment — Insufficient Response
Initial management—early complete surgical debridement where feasible, combined with first-line azole antifungal therapy—did not achieve stable disease or partial response with resolution of signs and symptoms of infection and substantial radiographical improvement on weekly imaging.
Salvage Approach (Partial Overview)
Salvage treatment centers on switching to an alternative azole antifungal strategy. The specific agent and formulation are guided by the full structured protocol.
Complete agent selection, formulation guidance, and dosing are available in the full evidence-based regimen below.
Treatment Goal
Stable disease or partial response, with resolution of signs and symptoms of infection and substantial radiographical improvement on imaging.
References
- In case of renal failure, posaconazole or isavuconazole were shown to be effective.
- Isavuconazole is strongly supported as salvage treatment.
- Posaconazole delayed release tablets or infusions are strongly supported for salvage treatment, and when available should be preferred over posaconazole oral suspension, which in turn is marginally supported for salvage treatment.
- Therapy can be continued until resolution of signs and symptoms of infection, and substantial radiographical improvement.
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