Maharashtra: Severe shortage of Ampho-B, drug of choice to treat Mucormycosis, raises concern

Pune and various districts across the state are facing an acute shortage of Amphotericin B (Ampho-B), which is given to Covid patients once they are diagnosed with Mucormycosis.

Several hospitals in the city and districts like Ahmednagar among others have started witnessing the scarcity of the drug.

There has been an increase in the number of Mucormycosis cases with one of the doctors even admitting to treating five to seven per day at a multispecialty hospital in Pune. Prior to Covid-19, the usage of Amphotericin B was limited as there were hardly any cases of Mucormycosis.

The demand for Liposomal Amphotericin B has shot up due to Covid-induced Mucormycosis, said Rohit Karpe, treasurer of the Association of Chemists in Pune district.

“Usually, in any hospital, there would be a requirement of up to 100 vials per month prior to Covid-19. Now the consumption per patient is up to 120 vials. Presently, the demand has shot up to 1,000-1,500 vials from hospitals to various distributors in Pune district,” Karpe said.

He added that they were informed that the drug’s production would be enhanced by Cipla, Bharat Serum, SunPharma and Mylan.

Doctors said to treat Covid-induced Mucormycosis, Amphotericin B is needed to be administered for almost two weeks.

“The drug was rarely used before as we had only one or two patients in a year who needed it. Hence, it was not produced a lot,” said Dr Parikshit Gogate, consulting ophthalmologist, who treats patients at Ruby Hall Clinic, D Y Patil Medical College and Hospital.

“Patients have to pay for their medicines in private hospitals and the cost of Amphotericin B ranges to an approximate Rs 7,500 per bottle. A patient may need 10 bottles per day and may require it for six weeks minimum. There are some patients, who are using it for six months too,” said Dr Aditya Kelkar, director at National Institute of Ophthalmology.

“I have seen five cases so far, but mostly, they are referred to the neuro-ENT infection control specialists in a multi-specialty hospital,” said Dr Kelkar, who visits facilities to treat the Covid patients, who suffer from ophthalmological ailments.

Dr Ramesh Murthy, eye surgeon at Deenanath Mangeshkar Hospital, which has treated the maximum cases of Mucormycosis, admitted to the shortage of Amphotericin B.

He said while alternative drugs like Posaconazole and Isavuconazole can be given, the drug of choice is Amphotericin B.

“I admitted six patients yesterday, and the only good thing is, I have been able to reduce or nearly stop the eye-removal surgeries for a fortnight due to newer techniques of surgery,” Dr Murthy said.

The surgery, known as orbital debridement, helps prevent the removal of eyes. At Bharati Hospital, Deputy Medical Director Dr Jitendra Oswal said they had recently treated 10 Mucormycosis patients and two died.

The state FDA has been monitoring the availability of the key drug. “We are getting details of the stock position from all our units but there is a shortage,” Shyam Pratappawar, assistant commissioner, FDA, said, adding that they are looking into the matter.