Doctors in Mumbai have been forced to turn to alternative and cheaper alternatives to treat COVID-19 patients affected by mucormycosis, or black fungus, as the anti-fungal drugs required to treat the condition are still in short supply, the Times of India reported.
The alternative —conventional amphotericin B—also costs a fraction at Rs 350 or lower per day for treatment compared to Rs 30,000 a day for treatment by liposomal amphotericin B, it said.
Dr Milind Navalakhe, ENT surgeon at Parel’s Global Hospital, which has treated over 35 patients in the past 60 days said the alternative was used as liposomal amphotericin B “has been in short supply for nine days”, adding “the conventional amphotericin B costs a fraction but gives equal results”.
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Liposomal amphotericin B has become the drug of choice for most doctors treating black fungus patients as it does not have sideeffects like headache, nausea or kidney damage, associated with the conventional alternative, the report added.
Further, the newer iteration also does away with the need for constant monitoring of the IV feed over a 16-hour period and instead consists of a daily course of six injections.
One doctor likened the new amphotericin to a ‘Rolls Royce’ of mucor medication while “the older one works too” but added that patients for this treatment would have to be “chosen carefully”.
Most patients at Global and neighbouring KEM Hospital are being treated with the conventional therapy. The latter is treating around 100-odd black fungus patients.
Government-run KEM Hospital’s Dean Dr Hemant Deshmukh said liposomal amphotericin B is being “reserved for the most seriously unwell and those without any kidney issues”.
Mumbai’s civic body, the Brihanmumbai Municipal Corporation (BMC) received 2,000 liposomal amphotericin B injections from the Maharashtra Food and Drugs Administration (FDA) on May 21 and is “in the process” of distributing it to government and private hospitals.
Dr Deshmukh, who is in charge of the distribution process, said each patient can get a two-day supply of 12 injections each and that BMC has asked for 1 lakh injections. The private sector will have to pay Rs 5,760 for an injection.
Dr Ashesh Bhumkar, who is part of Maharashtra’s task force on mucormycosis, said people are misinformed that there are no other options. He is trying to get Maharashtra to draw up guidelines to classify mucormycosis into its subtypes so that other antifungal medicines can be used. He added that “main treatment is surgery”.
The process for mucor surgery is similar to cancer, wherein the affected part if removed and medicines such as liposomal amphotericin B or conventional amphotericin B are only used once the fungal load is reduced via surgery, Dr Navalakhe said.
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