American Board of Internal Medicine (ABIM) Certification Practice Exam

Which is a first-line treatment for mucormycosis?

1. Fluconazole

2. Liposomal amphotericin B

3. Voriconazole

4. Caspofungin

The correct answer is: Liposomal amphotericin B

Liposomal amphotericin B is recognized as the first-line treatment for mucormycosis, a serious and often aggressive fungal infection caused by molds in the Mucorales order. This particular formulation of amphotericin B is preferred due to its efficacy against the pathogens responsible for mucormycosis, including Rhizopus and Mucor species, which are generally resistant to other antifungal agents. Amphotericin B operates by disrupting fungal cell membranes, leading to cell death. Its broad spectrum of action makes it particularly effective for deep tissue infections caused by these molds. Liposomal amphotericin B specifically offers advantages in terms of reduced nephrotoxicity and improved tolerability compared to conventional formulations, which is critical for patients who are often immunocompromised and may have pre-existing renal issues. The other options, such as fluconazole, voriconazole, and caspofungin, are used for different types of fungal infections. Fluconazole is most effective against Candida and some strains of Cryptococcus but does not have the necessary efficacy against the Mucorales. Voriconazole is primarily used for Aspergillus infections, while caspofungin is an echinocandin effective against certain