PUNE: Careful tracking of blood creatinine levels can do away with expensive mucormycosis medication, treating surgeons have found.
The liposomal form of the amphotericin injection — a key drug against the infection — can cost a patient Rs 35,000 every day.
The conventional form of the drug costs just Rs 350 per day, but needs to be given carefully with a blood test every alternate day to rule out drug toxicity in the kidneys.
If creatinine levels are raised, the 21-day course of the drug can be finished with two to three “pit stops”, also called “amphotericin holidays”, to allow the body to normalise levels.
Creatinine is a waste product that is channeled out of the system via the kidneys.
The efficacy is equal for both the expensive and cheaper forms of amphotericin.
But the conventional form (the cheaper version) should not be given to patients with significant comorbidities, including renal failure and diabetic ketoacidosis.
In the rest, conventional amphotericin can effectively arrest spread of mucormycosis.
All doctors need to do is strictly monitor blood creatinine levels and clear damaged tissue, experts said.
ENT surgeon Samir Joshi said, “Liposomal amphotericin is no doubt safer than the conventional one and everyone would want the safer version.
But there is no difference in efficacy in both forms of the drug.” Joshi, head of the ENT department at BJ Medical College and Sassoon Hospital, has treated about 201 patients with post-Covid mucormycosis.
“More than 85% of them recovered through monitored use of conventional amphotericin and careful debridement surgeries.
Their long-term follow-ups will consolidate this success rate,” he said.
Before Covid, Joshi had treated 65 mucormycosis cases using conventional amphotericin.
“Of them, 63 patients recovered,” he said.
Joshi said unwarranted concerns, that conventional amphotericin causes kidney damage, has led to “hyped demand” for the drug’s liposomal form.
“It is the fear of kidney damage in minds of people and physicians that has led to overrating of the liposomal form.
Careful monitoring with blood creatinine and few other tests can tide over this risk and allow effective use of conventional amphotericin,” Joshi said.
In fact, it is the combined use of amphotericin with surgery that does the trick.
Surgery removes dead and necrotic tissues.
Amphotericin then arrests advancing fungus in adjacent live tissue.
“Both are essential and complementary to each other,” Joshi said.
Sandeep Karmarkar, ENT surgeon with Ruby Hall Clinic, said, “Debridement (clearance) of all affected tissues is vital.
Only after thorough removal can the drug reach the target site.” Currently, neither conventional nor liposomal amphotericin is available easily as supply is limited.
“Liposomal amphotericin B is non-toxic, causes fewer electrolyte changes, higher dosages can be given within a short period of time and tissue penetration is better.
Only disadvantage is it’s costlier than conventional amphotericin and beyond the reach of many,” Karmarkar said.