Scramble for anti-fungal drug in Chandigarh

Naina Mishra

Tribune News Service

Chandigarh, May 16

After remdesivir and tocilizumab, the tricity region is now facing a shortage of Liposomal amphotericin B (L-AmB), which is used to treat Covid-associated mucormycosis (CAM), also known as “black fungus”.

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The PGI has been now reporting a high incidence of mucormycosis among patients of Covid 19, especially those who are diabetic and those who have received steroids. In the past three days, the institute has seen 21 cases of mucormycosis among Covid-19 patients.

Dr Arunaloke Chakrabarti, Head of Department of Microbiology, PGI, says that the Covid-associated mucormycosis (CAM) has been associated with high morbidity and mortality, exorbitant treatment costs and has led to a shortage of anti-fungal drugs such as amphotericin b.

“Poorly controlled diabetes is a major issue due to which CAM occurs. Good glycemic control during management of Covid 19 patients is required to prevent this. Systemic steroids should only be used in patients with hypoxemia. Oral steroids are contra indicated in patients with normal oxygen saturation on room air. If systemic steroid is used, blood sugar should be monitored,” said Dr Chakraborty.

Meanwhile, attendants are scrambling for the injection required to treat fungal infection.

“We urgently need liposomal amphotericin b 50mg injections for my mother admitted to the PGI for the past 21 days. She is Covid negative now but her lungs are badly damaged. The injection is very costly (Rs6-7K) and we can’t afford it. Besides, the injections are not even available anywhere in and around the city,” said the attendant of a 51-year-old patient admitted to the PGI.

Sandeep, another attendant, said: “My father has fungal infection in nose and eyes. This is 100 vial course and 48 vials have already been given to him. The drug is not available anywhere in the tricity and that is why we have shifted my father to the PGI. We require 52 vials more and the hospital has asked us to arrange the same. This is a very helpless situation.”

On the shortage of anti-fungal drug, Arun Gupta, Principal Health Secretary of UT, said: “The Centre has to take a call on the shortage of amphotericin. The ministry is considering allocating the drug to states on the pattern of remdesivir and tocilizumab.”

Symptoms of mucormycosis

• Initially: nasal blockade or congestion, nasal discharge (bloody or brown/black), local pain
• Facial pain, numbness or swelling
• Headache, orbital pain
• Toothache, loosening of maxillary teeth, jaw involvement
• Blurred or double vision with pain