CNS 5.3 Cerebral fungal infections – Mucorales

Recommendations

≥ 18 years
	Dosage	Remarks
1st choice	liposomal amphotericin B (Ambisome) IV 5 mg/kg once daily	Surgical debridement where possible. Treatment duration 6 weeks–6 months, guided by resolution of infection. If susceptibility is demonstrated, consider step-down to oral isavuconazole tablets under TDM
2nd choice	isavuconazole IV loading dose 200 mg, three times daily for 2 days followed by isavuconazole IV 200 mg once daily	For failure of, or intolerance to, Ambisome (including cerebral localisation)