Top private hospitals in Bengaluru have run out of Liposomal Amphotericin-B stock, even as there are 481 reported cases of mucormycosis in Karnataka. The infection, commonly called black fungus, needs the antifungal medication.
Hospitals which have runout of stock include, Minto Eye Hospital, Bowring and Lady Curzon Hospital, St John’s Medical College Hospital, HCG Hospital, The Quint has learnt.
Drugs Controller Confirms Shortage
A pharmacy executive at HCG Hospital said that they last received the stock of Amphotericin-B, 15 days ago.
“Amphotericin-B is not available. Even other drugs used for treating Mucormycosis including Posaconazole, are also out of stock,” a pharmacy executive of St John’s Medical College Hospital told The Quint.
When asked about the unavailability of the drug at major hospitals in the city, Karnataka Drugs ControllerBhagoji T Khanapure told The Quint, “There is no stock due to minimal production of the drug. We have written to the Center about the crisis. I’m aware of the shortage and we are working on finding a solution. Production needs to be ramped up.”
The Karnataka government had on 24 May requested the Centre for an allocation of 20,000 vials of Amphotericin-B. However, the Health Department on Wednesday, 26 May noted that the state has been allocated only 1,220 vials of the drug. As many as 2,300 vials were allocated till 24 May.
Karnataka’s requisition was based on the estimation that one patient will require about four vials of the drug per day over a treatment period of 10 to 12 days. Thus, about 50 vials would be required per patient during their treatment period.
No Alternatives Available
According to reports, the most commonly used anti-fungal medicine is Liposomal Amphotericin-B injection. If that is not available, the next choice is Amphotericin-B Deoxycholate (plain) injection, and a third option is Isavuconazole, manufactured by Pfizer in tablet and injectable forms.
A fourth option that is available is Posaconazole, a generic medication that comes as both tablet and injection.
Amphotericin is presently manufactured by Bharat Serums & Vaccines, BDR Pharmaceuticals, Sun Pharma, Cipla, and Life Care Innovations. Mylan imports the drug and supplies in India.
All manufacturers were together estimated to produce 1.63 lakh vials of Amphotericin-B in May, the Centre said in a release on 21 May. Another 3.63 lakh vials were in the process of being imported, the release read. However, data released by the Centre show that only 67,930 injections of Amphotericin B have been allotted to the states for the period between 10 May and 31 May; much less than their requirement.
The Centre has said domestic production will be scaled up to 2.55 lakh vials in June, and another 3.15 lakh vials will be imported, taking total supplies to 5.70 lakh vials.
On 20 May, the Delhi High Court stressed the need for immediate imports, since domestic production has been “far less” than the requirement across India. “Looking at the substantial shortfall in the requirement, we are afraid that these steps may not suffice to meet the current requirements. It is not clear as to by when the augmented production plans would come into actual production,” the court said last week.
Deadly Infection
Black fungus is an aggressive infection that first develops in the nasal tract, travels towards the eye, and then the brain. It can be fatal if it spreads to the brain. It is being detected in several people who recovered from COVID-19. Patients who received high doses of steroids or were on oxygen support during their COVID treatment are thought to be particularly vulnerable.
As many as 24 states and Union Territories in the country have reported cases of Mucormycosis so far.
While Gujarat has reported 2,859 such cases, Maharashtra has reported 2770. Andhra Pradesh (768), Madhya Pradesh (752), Telangana (744), Uttar Pradesh (701) and Karnataka (481), have also reported cases as of 25 May.the
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