An adult patient with newly diagnosed rhino-orbital-cerebral mucormycosis is haemodynamically stable and scheduled for urgent debridement. Which systemic antifungal agent is the accepted first-line therapy alongside surgery?

• A Voriconazole
• B Liposomal amphotericin B ✓
• C Fluconazole
• D Caspofungin monotherapy

Explanation

Mucorales are uniformly resistant to voriconazole and fluconazole, so these agents have no role as initial therapy despite being first-line for aspergillosis. High-dose liposomal amphotericin B combined with aggressive surgical debridement and reversal of risk factors such as hyperglycaemia remains the standard of care. Echinocandins like caspofungin lack reliable activity as monotherapy against Mucorales and are considered only in combination regimens when amphotericin is contraindicated.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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