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After Remdesivir and Tocilizumab, the Tricity is witnessing an acute shortage of Liposomal Amphotericin B, a life-saving drug crucial for the treatment of mucormycosis or black fungus. The steep rise in the cases of mucor among patients who have just conquered Covid-19 is behind this shortage.
No one knows it better than Arvind Sharma, whose father, a 73-year-old retired police official was admitted to the Covid ward of GMCH-32 on April 30 after his condition deteriorated. A day after he tested negative for Covid on May 13, he started showing symptoms of mucormycosis. He is in the ICU for the last two days, while Arvind struggles to find vials of Liposomal Amphotericin B.
“I was able to arrange almost four doses from a pharmacy in Chandigarh at the cost price. Then I arranged a few from a family in Delhi who no longer needed it as their patient had passed away. Now its supply seems to have dried up, I haven’t been able to get any for the last 2-3 days. We have doses for only two more days,” he says.
Rajiv Sharma (51) from Delhi, who was getting treated for Covid at a private hospital in Mohali since April 30, couldn’t get even a single dose. He suddenly lost vision in both his eyes on May 6, and passed away before his family could get the drug.
Saksham, whose father Balesh Kumar (54) was admitted at GMCH-32 for more than a month after testing positive on April 11, is now running from pillar to post to arrange the drug for his father.
“The Government has been providing extremely limited stocks. Doctors fear the supplies may run out any time, so they request patients to arrange for backup. But where do we to get it from,” he asks, adding, “It is not available anywhere.”
His father, still battling post-Covid complications which led to lung fibrosis, was discharged on May 17 but had to be brought back on May 19. “His mucor cultures taken on May 12 showed growth, which proved he had mucormycosis that requires immediate treatment. We feel battered. It has been such a long journey. We had even bought an oxygen concentrator and cylinders, but he had to be brought back,” he says.
Saksham says some unscrupulous elements have taken to black marketing the drug. “My father needs 70 vials. Even if I buy these at a cost price of Rs 7000- Rs 8000, it still aggregates to more than 5 lakh. We are privileged and can afford this. But when each vial is being black marketed at Rs 25,000, even we cannot afford it,” he rues.
The Miracle Drug
Speaking to The Indian Express, Professor Arunaloke Chakrabarti, Head, Department of Medical Microbiology, PGI, and in charge, Centre of Advanced Research in Medical Mycology, says, “Liposomal Amphotericin B is the most effective drug in the treatment of mucor cases.”
As per recommendations by the Fungal Infection Study Forum on antifulgal therapy in Covid associated mucormycosis, a dose of Amphotericin B must be started from the very first day. Dr Chakyabarti also states that other antifungal prophylaxis are not active against mucor and are thus not recommended.
The medication is required to continue for at least 3-6 weeks. “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,” says Dr Chakrabarti.
Mucormycosis In Chandigarh
Prof Ashok Kumar, Official Spokesperson, PGIMER, said, “We have dedicated beds for Mucormycosis cases in the Nehru Hospital Extension RT surgery ward. Liposomal Amphotericin shortage is there but the government is seized of the issue and all efforts are being made to procure it.”
A UT spokesman said as on Thursday a total of 23 Mucormycosis cases were admitted in various city hospitals, including 16 at PGI and 7 at GMCH 32.
As per doctors more than 50 cases of black fungus are currently active in UT. Treatment for each requires more than 50 vials of the drug.
20 Cases At Mohali
As per DC Girish Dalyan, while no beds have been reserved for those reporting with the disease as “most Covid patients getting the fungus have already tested negative”, the state as per orders passed on Wednesday, has stated that the drug will be made available centrally.
“Liposomal Amphotericin B will be provided by the state government to designated government and private Covid hospitals at a cost of Rs 1424.82, the same rate at which procurement has been made by the NHM,” said the DC.
Mohali is yet to receive the stocks of the medicine.
Dayalan further said that more than 20 cases of black fungus have been treated at Mohali. “Most of them are from Delhi NCR,” he said. Five of them have also been operated upon.
Only 2 In Panchkula
Panchkula DC Mukesh Kumar Ahuja said beds have been reserved as per instructions from the state at the Maharishi Markandeshwar Institute of Medical Sciences and Research at Maulana, Ambala, for patients of black fungus from Panchkula district.
“We have only had two patients as of yet, one of whom was referred to PGI. The one detected today will be referred to Medical college Ambala,” says Ahuja.
As for the drug, Ahuja said the hospital treating the patient will be responsible for arranging it. “All medical colleges of the state are already getting a steady supply as per their requirement. Any cases in private hospitals too would be referred to state facilities where drug will be readily available,” he said.
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