PUNE: Careful tracking of blood creatinine levels in patients battling post-Covid mucormycosis can ease the pain of daily medication costs from Rs 35,000 to Rs 350, treating surgeons have found.
While the liposomal form of amphotericin injections — a key drug against the infection — is prohibitively priced, the conventional form of the same drug costs 100 times less but needs to be administered 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.
Creatinine is a waste product that’s channeled out of the system via the kidneys.
ENT surgeon Samir Joshi said “unwarranted” concerns over conventional amphotericin causing kidney damage had led to the “hyped demand” for the drug’s liposomal form.
“We should dispel this fear”.
The efficacy of both forms of amphotericin is equal, say doctors.
The catch is that the drug in its conventional form should not be given to patients with significant co-morbidities, including renal failure and diabetic ketoacidosis.
In the rest, conventional amphotericin can effectively arrest spread of mucormycosis, specialists have found out.
All a treating doctor needs to do is strictly monitor blood creatinine levels and clear damaged tissue.
“Liposomal amphotericin is, no doubt, safer than the conventional one and everyone would want the safer version.
But there is no difference in efficacy of both forms of the drug,” said Joshi, head of the ENT department at Pune’s BJ Medical College and Sassoon General Hospital.
He has treated about 201 patients with post-Covid mucormycosis.
“More than 85% of these patients successfully recovered through monitored use of conventional amphotericin and carefully planned debridement surgeries.
Their long-term follow-ups will consolidate this success rate.” Before Covid struck, Joshi had treated 65 patients with mucormycosis using conventional amphotericin.
“Of them, 63 patients recovered and have survived,” he said.
The combined use of amphotericin and surgery usually works.
Surgery removes the dead and necrotic tissues.
Amphotericin then goes on to arrest advancing fungus in adjacent live tissue.
ENT surgeon Sandeep Karmarkar said, “debridement (clearance) of all affected tissues is extremely vital.
Only after a thorough removal will the drug be able to reach the target site”.
Currently, neither the 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,” he said.