This protocol applies to patients with rhino-orbital-cerebral mucormycosis (ROCM) who have pre-existing renal compromise or renal failure, and whose first-line treatment did not achieve the required level of disease control on serial imaging.
The patient presents with ROCM in the context of pre-existing renal compromise or renal failure. In this setting, posaconazole or isavuconazole have been shown to be effective antifungal options, as they can be used without the nephrotoxic risk carried by standard amphotericin B formulations.
First-line management comprised early complete surgical debridement combined with immediate systemic antifungal therapy selected to avoid amphotericin B — specifically isavuconazole or posaconazole, given intravenously. The required treatment goal was at least stable disease or a partial response on response assessment (typically weekly imaging). This salvage protocol is indicated when that threshold was not met and disease progression continues.
Salvage therapy involves switching to the other available triazole antifungal agent, or — where the patient’s renal status permits — introducing a lipid-based formulation. Agent selection, sequencing, and any adjustments required by renal function are specified in the full structured protocol.
Complete resolution of the initially indicative mucormycosis findings on imaging. Treatment should continue until that imaging response is achieved alongside reconstitution of host immune function.