Rhino-orbital-cerebral mucormycosis (ROCM) in adult solid organ transplant recipients demands immediate, coordinated management. This protocol addresses the structured evidence-based approach for this specific patient population.
Adult solid organ transplant recipient presenting with rhino-orbital-cerebral mucormycosis. Transplant-associated immunosuppression places these patients at elevated risk for invasive mould infection, shaping the urgency and character of the required response.
Management combines early surgical intervention with immediate systemic antifungal therapy — both are initiated together from the outset rather than in sequence. Depending on response, a transition to oral antifungal therapy may follow. The complete protocol — including agent selection, sequencing, and criteria for each step — is available via the link below.
Achievement of stable disease or partial response of mucormycosis, assessed on regular imaging (e.g. weekly).
The guideline group strongly supports an early complete surgical treatment for mucormycosis whenever possible, in addition to systemic antifungal treatment.
In kidney transplant recipients, amphotericin B lipid complex 10 mg/kg per day has been given.
Doses should not be slowly increased over several days; rather, the full daily dose should be given from the first treatment day.
When switching to oral treatment, use of isavuconazole or posaconazole delayed release tablets is strongly supported.
There is moderate support for intravenous treatment until stable disease is achieved.
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