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- Title
Recent advances in the management of mucormycosis: from bench to bedside.
- Authors
Spellberg, Brad; Walsh, Thomas J; Kontoyiannis, Dimitrios P; Edwards, John, Jr; Ibrahim, Ashraf S
- 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 mucormycosis. 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.
- Publication
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2009, Vol 48, Issue 12, p1743
- ISSN
1537-6591
- Publication type
Journal Article
- DOI
10.1086/599105