Doctors racking brain for workable combo in absence of Amphotericin B

Nagpur: The sudden shortage of Amphotericin B family (Liposomal, Deoxycholate and Lipid Emulsion) has pushed medical experts to brainstorm over alternative therapies through different combinations of drugs to tackle mucormycosis in Covid-recovered patients. Posaconazole, an add-on drug which is many times prescribed during discharge, is also in short supply.

The doctors have already been trying different combinations as Amphotericin B family of drugs had got gradually exhausted from the shelf of chemists. Now, it’s reliably learnt that a group of senior doctors and Covid task force are brainstorming over forming a treatment protocol and guidelines for mucormycosis.

Sources stated the committee would try to formulate a guideline regarding the usage of drugs as per mild, moderate and severe cases. This is the protocol for the anti-viral drug Remdesivir too. The government is also likely to take a decision to regulate the drug’s use.

Dr Prashant Nikhade, president of the Ear, Nose and Throat (ENT) Doctors’ Association, said patients cannot be made to wait for the Amphotericin B crisis to get over as the fungal growth is quick and life-threatening. “We need to explore the options of using drugs like Posaconazole or Isavuconazole. Amphotericin B will remain the primary line of treatment. Isavuconazole is part of the Azole derivative (Triazole). Though the efficacy of Isavuconazole is not as high as Amphotericin B, it will keep the fight on,” he said.

Like Nikhade, several other doctors too shared their experience stating Azole blocks the synthesis of the Ergosterol which is an important component of the fungal cell. ENT specialist Dr Samir Thakare of New Era Hospital suggested yet another Triazole derivative — Itraconazole — saying that it may be used as treatment cannot be stopped.

“Though Itraconazole does not have a promising role, we have limited options in the absence of the key drug,” said Dr Thakare.

Well-known physician Dr Mohan Nerkar of Seven Star hospital said Posaconazole and Isavuconazole are merely add-ons but can be administered to the patients if the primary drug (Ampho) is not available anywhere. “The drugs like Voriconazole, which acts better on Aspergillus, can be used too in mucormycosis as a compromise,” he said.

Dr Ravindra Sarnaik, top pulmonologist and a member of the Covid task team, suggested the use of Caspofungin as an alternative. “We have to explore the uses of both mono and combination therapies,” he said.

Several experts are now also suggesting the use of Echinocandins which are the relatively new class of anti-fungal agents.