Alternate-Day Amphotericin B Therapy in the Treatment of Rhinocerebral Phycomycosis (Mucormycosis)

Abstract

Successful treatment of rhinocerebral phycomycosis is limited because of late diagnosis, resistance of the etiological agents to antifungal drugs, inaccessability of the lesions and the fulminant nature of the disease, especially in patients with diabetic acidosis. Two diabetic patients with rhinocerebral phycomycosis and acidosis were successfully treated by alternate day amphotericin B administered intravenously at 1.2 mg/kg, control of the diabetic acidosis, local surgical excision of involved sinus tissues and irrigation of paranasal sinuses with amphotericin B. Mean 48 hr. amphotericin B serum levels were 0.34 [mu]g/ml and 0.45 [mu]g/ml respectively in the 2 patients. The minimal inhibitory concentration of amphotericin B for Rhizopus oryzae in 1 patient was 1000 [mu]g/ml. Although the high blood level of amphotericin B needed to inhibit growth of the organism is unattainable using ordinary doses, the drug is known to be effective in vivo in phycomycete-infected animals and should be part of the therapeutic regimen in human phycomycosis. Renal function was best measured by creatinine clearance determinations which showed a decrease during amphotericin B therapy. This decrease was reversible. Alternate day therapy with intravenously administered amphotericin B produced serum levels of the drug 48 hr. after infusion which are considered adequate for most of the systemic mycotic agents. This regimen was tolerated better by the patients and may have offered less hazard of renal damage during treatment than daily therapy.