Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: a prospective cohort study
Issued Date
2023-01-01
Resource Type
ISSN
1198743X
eISSN
14690691
Scopus ID
2-s2.0-85164720738
Pubmed ID
37348653
Journal Title
Clinical Microbiology and Infection
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Microbiology and Infection (2023)
Suggested Citation
Manesh A., Devasagayam E., Bhanuprasad K., Varghese L., Kurien R., Cherian L.M., Dayanand D., George M.M., Kumar S.S., Karthik R., Vanjare H., Peter J., Michael J.S., Thomas M., Mathew B.S., Samuel P., Peerawaranun P., Mukaka M., Rupa V., Varghese G.M. Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: a prospective cohort study. Clinical Microbiology and Infection (2023). doi:10.1016/j.cmi.2023.06.017 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/88059
Title
Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: a prospective cohort study
Other Contributor(s)
Abstract
Objectives: To evaluate the efficacy and safety of short-course intravenous amphotericin B followed by sustained release posaconazole tablets for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis. Methods: This prospective, pragmatic study included adults with diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis. Patients received short (7–14 days) or long (15–28 days) intravenous antifungal therapy (short intravenous antifungal treatment [SHIFT] or long intravenous antifungal treatment [LIFT], respectively) depending on the presence or absence of brain involvement. All patients received step-down posaconazole tablets, debridement, and glycemic control. The primary outcome was the treatment success at week 14, which was determined by assessing survival and the absence of disease progression through clinical evaluation and nasal endoscopy. Log-binomial regression analysis (risk ratio and 95% CI) was performed to assess factors associated with the primary outcome. Results: Intravenous therapy was administered to 251 participants: SHIFT, 205 (median duration, 13 days); LIFT, 46 (median duration, 22 days). Treatment success at 3 months was 88% (217/248; 95% CI, 83–91%): SHIFT group, 93% (189/203; 89–96%); LIFT group, 62% (28/45; 47–76%). All-cause mortality was 12% (30/251): SHIFT group, 6% (13/205); LIFT group, 37% (17/46). Age (aRR [95% CI]: 1.02 [1.00–1.05]; p 0.027), diabetic ketoacidosis at presentation (2.32 [1.20–4.46]; p 0·012), glycated haemoglobin A1c (1.19 [1.03–1.39]; p 0.019), stroke (3.93 [1.94–7.95]; p 0·0001), and brain involvement (5.67 [3.05–10.54]; p < 0.0001) were independently associated with unsuccessful outcomes. Discussion: : Short intravenous amphotericin B with step-down posaconazole tablets should be further studied as primary treatment option for diabetes or COVID-19-associated mucormycosis in randomized controlled trials.