BENGALURU: There has been an “exponential” increase in cases of Covid-Associated Mucormycosis (CAM), or black fungus, in Bengaluru over the last 10 days, but the all-importantanti- fungal drug Liposomal Amphotericin or Amphotericin- B has surprisingly gone out of stock! In its absence, some hospitals are either using other alternative drugs, which may not be as effective as Amphotericin-B or are using plain Amphotericin, which is nephro-toxic and has the potential to damage kidneys.
Some private hospitals, which have operated upon CAM patients are frantically looking for Amphotericin-B and even calling government and government hospitals for some vials. “Amphotericin- B was easily available in the market till recently. It is not available now,” said Medical Director of Sri Bhagwan Mahaveer Jain Hospital, MD Marker.
“There is an increase in CAM cases and we urgently require Amphotericin- B,” he added. “Liposomal Amphotericin enables us to use higher doses without the toxicity associated with plain Amphotericin. Higher doses ensure better and quicker eradication of the fungus. Unfortunately, the supply of Amphotericin- B is inadequate, given the current demand.
The only option left is to improve immunity with better control of diabetes and removal of dead tissue from the nose and sinuses to lower the fungal load and use second line drugs like Posaconazole or Isavuconazole.
This has to be done at the earliest to prevent the spread to the eyes, resulting in loss of vision, and spread to the brain, which can result in loss of life,” said Dr E V Raman, consultant ENT specialist, Manipal Hospital, Old Airport Road. Dr Athira Ramakrishnan, consultant ENT specialist, Fortis Hospital, Bannerghatta Road, also admitted that there was a “shortage of Amphotericin- B due to the sudden surge in the number of cases.”
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“In normal circumstances, a busy tertiary referral centre sees around 12 to 15 cases in a year, so the medication is stocked accordingly. Amphotericin is the first choice of medication.
There are other antifungal medications like Posaconazole, Isavuconazole that can be used as alternatives, but they may not be as effective as Amphotericin-B,” Dr Athira Ramakrishnan said.
“There has been a significant rise in Mucormycosis cases and it mostly affects the lungs and sinuses because of the use of steroids, inadequate monitoring of blood sugar level, altered innate immunity, invasion of vessels and formation of clots.,” said Dr Girish Anand, consultant ENT specialist Aster CMI Hospital, Hebbal. Many messages have also been circulating on social media platforms inquiring about the availability of the drug.
The State Government has formed a CAM Task Force and the Centre, after notifying it as an epidemic, on Thursday said that the shortage of Amphotericin B will be resolved. Its production has been ramped up by the existing six companies and five more firms have received approval for producing it in India. Union Minister Mansukh Mandaviya tweeted that Indian firms have placed orders for importing 6 lakh vials of Amphotericin-B.