Recent advances in the management of mucormycosis: from bench to bedside

Brad Spellberg, Thomas J. Walsh, Dimitrios P. Kontoyiannis, J. John Edwards, Ashraf S. Ibrahim

Research output: Contribution to journalReview articlepeer-review

Abstract

Recent therapeutic advances have the potential to improve outcomes of mucormycosis. Lipid formulations of amphotericin B (LFAB) have evolved as the cornerstone of primary therapy for mucormycosis. Posaconazole may be useful as salvage therapy, but it cannot be recommended as primary therapy for mucormycosis on the basis of available data. Preclinical and limited retrospective clinical data suggest that combination LFAB-echinocandin therapy may improve survival during mu- cormycosis. A definitive trial is needed to confirm these results. Combination therapy with LFAB and the iron chelator, deferasirox, also improved outcomes in animal models of mucormycosis. In contrast, combination polyene-posaconazole therapy was of no benefit in preclinical studies. Adjunctive therapy with recombinant cytokines, hyperbaric oxygen, and/or granulocyte transfusions can be considered for selected patients. Early initiation of therapy is critical to maximizing outcomes; recent developments in polymerase chain reaction technology are advancing early diagnostic strategies. Prospective, randomized clinical trials are needed to define optimal management strategies for mucormycosis.

Original languageEnglish (US)
Pages (from-to)1743-1751
Number of pages9
JournalClinical Infectious Diseases
Volume48
Issue number12
DOIs
StatePublished - Jun 15 2009

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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