This protocol applies to patients with rhino-orbital-cerebral mucormycosis whose initial management — combining surgical debridement with first-line systemic antifungal therapy — has not resulted in stable disease or a partial response on imaging assessment.
The preceding treatment consisted of early complete surgical debridement (performed whenever feasible, repeated as required) together with immediate systemic antifungal therapy with liposomal amphotericin B.
Escalation to this salvage protocol is warranted when that approach does not achieve stable disease or a partial response on response assessment — for example, on weekly imaging.
At this stage, management centres on switching to a different antifungal class. For cases involving rapid progression or extensive disease, escalation to higher-dose lipid-based antifungal formulations — optionally used in combination — is among the approaches described in the full protocol.
Complete agent selection, clinical decision points, and sequencing are detailed in the structured evidence-based regimen below.
The primary target is complete response: full resolution of the initially indicative mucormycosis findings on imaging.