Drug crunch hits patients with black fungus in Bihar
The two top medical institutions in Bihar — Patna’s All India Institute of Medical Sciences (AIIMS) and the Indira Gandhi Institute of Medical Sciences (IGIMS) — are facing an acute crisis of drug for treating patients with mucormycosis or black fungus, associated with coronavirus.
Liposomal Amphotericine-B injection, a specific drug for the fungal infection, has flown off the shelves.
The AIIMS, which has around 65 patients of black fungus, is struggling in the absence of drugs.
“It will be butchery if we operate upon patients and don’t make drugs available. Surgery is 50% cure, the remaining 50% recovery is through drugs,” said a doctor.
With 98 patients out of the total 109 admissions and eight deaths, the IGIMS has the highest number of patients with black fungus in any health facility in the state, said Dr Bheem Ram, assistant professor of medicine, IGIMS. Its stock of Amphotericin-B is enough to barely last a day.
The IGIMS received 500 vials and AIIMS 400 vials of Liposomal Amphotericin-B on Wednesday evening after the two institutes sent SOS to the state health department. Their stock has now exhausted.
The AIIMS had earlier received 2,000 vials and the IGIMS 1,300 vials of the injection.
“We have around 65 patients of mucormycosis. Each patient requires between six and 12 vials of Amphotericin-B injection per day. The drugs replenished are woefully inadequate to last even a day. The drug is out of stock,” said Dr Kranti Bhawna, additional professor and head of ENT department at AIIMS-Patna.
To make matters worse for the AIIMS, its empanelled vendors have refused to supply Amphotericin-B at the approved rate of ₹1,700 per vial after the Centre agreed to purchase it at ₹4,000 to ₹6,000 per vial from manufacturers.
Purchasing the drugs is a costly proposition for patients, given that its average daily requirement is 6-12 vials per patient a day, considering the patient’s body weight — more the weight, higher the drug requirement. The state government, which declared mucormycosis a notifiable disease on May 22, has decided to supply it free to patients.
Meanwhile, the IGIMS, a dedicated Covid-19 hospital, on Thursday initiated an integrated outdoor patient department (OPD), comprising experts from the ophthalmology, ENT and neurology departments for patients with mucormycosis. “The idea is to facilitate patients so that they don’t have to run about and wait in queues subsequently when referred for consultation from OPD of one department to another,” said Dr Manish Mandal, medical superintendent, IGIMS.
“The experts in our integrated OPD unit for patients with mucormycosis will evaluate patients and decide on their admission for treatment. Those who are very serious and unstable will be examined and admitted in emergency,” added Dr Mandal.
The government, on the other hand, defended itself.
“We have made available 10,000 vials of the drug to hospitals, including private, across the state. Since the drugs supplied are not one-time allotment, they are being replenished continuously, as per availability. We are relocating drugs from facilities having no patient of black fungus to those where the patient burden is high. We are also purchasing drugs directly from manufacturers. There is some supply issue, which we hope to tide over soon,” said an official of the health department, handling the allotment of Amphotericin-B.
Used in the treatment of kala-azar, Bihar had some stock of Liposomal Amphotericin-B, which it had received from the WHO. It diverted 10,000 vials of the drug for treatment of mucormycosis after obtaining the Centre’s nod.
Bihar reported 14 deaths and 244 cases of mucormycosis till Wednesday after the first case of mucormycosis was reported in the state late last month.
The mucormycosis misery
Cases and deaths
Bihar reported 14 deaths and 244 cases of mucormycosis till Wednesday after the first case of mucormycosis was reported in the state late last month. AIIMS-Patna has 65 patients while IGIMS in the state capital has 98. Both are faced with an acute crisis of the drug used to cure black fungus.
Injection for infection
Liposomal Amphotericine-B injection, a specific drug for fungal infection, has flown off the shelves. Since it’s used in the treatment of kala-azar, Bihar had some stock, which it had received from the WHO. It diverted 10,000 vials of the drug for treatment of mucormycosis after obtaining the Centre’s nod.
A drug gone dearer
At AIIMS-Patna, empanelled vendors have refused to supply the drug at the approved rate of ₹1,700 per vial after the Centre agreed to purchase it at ₹4,000 to ₹6,000 per vial from manufacturers. Average daily requirement is 6-12 vials per patient a day. More a patient’s body weight, higher the drug requirement.