Treatment for mucormycosis includes which combination therapy?

• A. Voriconazole
• B. Itraconazole
• C. Fluconazole
• D. Amphotericin B (liposomal) with surgical debridement

Answer: (D)

Mucormycosis demands two aggressive moves from the start: rapid surgical removal of all necrotic tissue and high-dose systemic antifungal therapy, with liposomal amphotericin B as the cornerstone. The organisms invade vessels and cause extensive tissue necrosis, so antifungals alone often can’t reach the infected areas; removing dead tissue decreases fungal burden and improves drug penetration. The liposomal form of amphotericin B provides effective antifungal activity with less nephrotoxicity than conventional amphotericin B, making it the preferred option for initial therapy. After stabilization, other antifungals like posaconazole or isavuconazole can be used for step-down or salvage treatment, but they are not typically first-line. Drugs such as voriconazole, itraconazole, or fluconazole lack reliable activity against Mucorales and are not appropriate as primary therapy.