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Journal of the Egyptian Public Health Association

Table 2 The updated ECMM/MSG-ERC treatment guidelines for mucormycosis [16]

From: A peek behind the curtain in the diagnosis and management of COVID‑19‑Associated Mucormycosis (CAM)

Drug(s)

Position of Treatment

Strength of Recommendations

Amphotericin B lipid complex, high-dose liposomal amphotericin B*

First-line monotherapy

Strong

Isavuconazole: intravenous or oral†

First-line or Salvage

Moderate

Posaconazole: intravenous or delayed-release tablets†‡

Salvage

Moderate

Posaconazole: oral suspension**

First-line monotherapy

Marginal†

  1. N.B. Amphotericin B deoxycholate is discouraged, because of significant toxicity—but it may be the only option in limited-resource settings. In cases of failure with isavuconazole or posaconazole, all three lipid-based amphotericin B formulations are recommended (i.e., moderate-to-strong). * Five to ten mg/kg/day of liposomal amphotericin B as a first-line treatment is strongly advocated irrespective of involved organs. The dose can be reduced if significant renal toxicity develops, but those less than five mg/kg/day are recommended but with marginal strength. ** Particularly when formulations with higher exposure are readily available. † Posaconazole or isavuconazole may be used as maintenance therapy. ‡ Primary prophylaxis with posaconazole may be recommended in neutropenic patients, those with graft-versus-host disease (GVHD), or high-risk factor
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