The Black Fungus Treatment –Liposomal Amphotericin B

The Black Fungus Treatment – Liposomal Amphotericin B

 

Treatment for Back Fungus –

 

  1. Antifungal Therapy –

Black fungus infection is treated with some specific antifungal medicines which need to be administered intravenously. The treatment starts off with giving antifungal medicines like Liposomal Amphotericin B, Isavuconazole and Posaconazole; through IV (intravenous) or in oral form for several weeks (4-6 weeks). Most frequently Amphotericin B is used as the first – line treatment for it. It is very important to monitor the renal function and potassium levels of the patient while giving Amphotericin B. After the initial 4-6 weeks of Amphotericin B treatment, the next step is the consolidation or the strengthening treatment which is started by giving either of Isavuconazole or Posaconazole. Patients who are intolerant to Amphotericin B, for them alternate medicines like Isavuconazole and Posaconazole can be used.

 

  1. Endoscopic Surgery –

While it is treated with antifungals, in some severe cases black fungus may eventually require surgery. In some serious cases of Gastrointestinal, Rhinocerebral and Cutaneous fungi (these are some types of fungal infection caused by black fungus) a surgery is conducted to remove the infected tissue in addition to the above antifungal medicinal treatment. Patients are regularly and continuously monitored clinically with the radio-imaging process for tracking the development of the response/disease.

(1,2 & 5)

 

 

What is an Amphotericin B injection and what are its types? Also, what is the difference between Amphotericin B and liposomal Amphotericin B?

Amphotericin-B injection is the major treatment injection for the treatment of this Black Fungus infection. The injection is an antifungal medicine. It works by slowing the growth of the fungi causing the infection. If infected, the patient has to be kept under the strict supervision of ENT specialists, eye surgeons, and neurosurgeons as the infection affects different parts of the body simultaneously.

These Amphotericin B medications are given mainly through a vein (intravenous or IV) or as pills (after the infection has reduced).

For IV purposes, this medicinal injection has two types–

·Deoxycholate – often referred to as ‘conventional’ Amphotericin

·Liposomal – AmBisome (LAMB) is a lipid-associated formulation of Amphotericin B for injection for much safer use

 

What is the difference between Amphotericin B and liposomal Amphotericin B?

Amphotericin B has been used to treat fungal infection for many years now. Although effective, this drug could cause kidney damage in about almost eight out of ten patients treated. People with kidney damage have to stay longer in hospital, have increased healthcare costs, and higher numbers of deaths. To avoid these problems known to affect people who need treatment for fungal infection, new formulations of amphotericin B (called lipid‐associated) have been developed. Liposomal Amphotericin B (also known as AmBisome) is a lipid-associated formulation of the broad-spectrum polyene antifungal agent Amphotericin B. Liposomal Amphotericin B is a liposomal formulation of Amphotericin B for injection and consists of a mixture of phosphatidylcholine, cholesterol and distearoyl phosphatidylglycerol that in aqueous media spontaneously arrange into unilamellar vesicles which contain amphotericin B. This is the most trusted and most used injection formula to treat Black Fungus in people recovered from COVID.

Liposomal Amphotericin B is as effective as the conventional Amphotericin B for empirical antifungal therapy in patients with fever and neutropenia. Liposomal amphotericin B is a new formulation and is most often used in clinical practice to treat fungal infection. And it is also associated with fewer breakthrough fungal infections, less nephrotoxicity and less infusion-related toxicity compared to Amphotericin B.

Current evidences from various studies and researches suggest that liposomal amphotericin B is less nephrotoxic than conventional (normal) Amphotericin B. In numerous in vitro and in vivo studies, it’s been proved that Liposomal Amphotericin B remains closely associated with the liposomes in the circulation, thereby reducing the potential for nephrotoxicity and infusion-related toxicity associated with conventional amphotericin B. Given the differences in toxicity and efficacy between Amphotericin B and Liposomal Amphotericin B, studies have also suggested that these differences can have different results on the quality of care and patient safety. The studies have also showed that the differences in their toxicity levels have resulted in marked variations in therapeutic indices. Also, Liposomal Amphotericin formulation accumulates in lungs in much better way than Amphotericin B. Liposomal amphotericin B is also known to be less nephrotoxic than conventional amphotericin B.

Because of the significantly lower toxicity levels, fewer fungal infections, fewer infusion-related side effects and less nephrotoxicity, for Liposomal Amphotericin B (AmBisome) and its better brain penetration is preferred to treat the black fungus in people recovered from covid-19 as compared to other Amphotericin B formulations.

Based on comparative data from various well controlled trials, extensive clinical experience and its broad spectrum of activity, Liposomal Amphotericin B remains the first-line option for empirical therapy in patients with febrile neutropenia and in those with various antifungal infections like the current black fungus. (3&4)

 

Reference List –

  1. Fungal Infection Study Forum (FISF), Covid-19 Associated Mucormycosis.
  2. NIH Endoscopic Surgical Treatment of Rhino-Sinusal Mucormycosis.
  3. M.D.Moen and L.J.Scott (2009), “Liposomal Amphotericin B – Its Review of its Use as Empirical Therapy”.
  4. Oliver A Cornely et al, “Global Guidelines for the Diagnosis & Management of Mucormycosis: An Initiative of the European Confederation of Medical Mycology”, Vol-19(12), 01/12/2019.
  5. Financial Express (2021), “Black Fungus: Doctors Explain Causes, Symptoms, Treatment and Precautionary Measures”

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