PUNE : The Joint National Task Force for Covid-19 has advised ‘salt loading’ as a key intervention to prevent or reduce conventional Ampho’s (Amphotericin B) harmful effects on kidneys of patients with Covid-associated mucormycosis (CAM). The drug can trigger nephrotoxicity if used without adequate monitoring.
Salt loading involves administering saline solution (salt water) into the patient’s vein through drip before, during, or after infusion of conventional Amphotericin B.
“Studies in humans have clearly demonstrated that salt loading can prevent or alleviate an amphotericin B-induced rise in serum creatinine (nephrotoxicity) as compared to water loading in patients receiving conventional amphotericin B,” said infectious disease expert Sanjay Pujari, member of the national task force.
Experts have been pushing for conventional amphotericin against Covid-associated mucormycosis as it is much cheaper than the drug’s liposomal variety, which is 100 times more expensive and beyond the reach of many. Guidelines issued by the Centre have also stated that the conventional form is equally efficacious in the treatment of CAM.
The liposomal form of Amphotericin B can cost a patient Rs 35,000 every day. The conventional form of the drug costs just Rs 350 per day, but needs to be given carefully with a blood creatinine test conducted every alternate day to rule out drug toxicity in the kidneys.
Conventional amphotericin causes a 50% increase in serum creatinine in about a third of patients. Higher doses for a longer duration can increase the risk of nephrotoxicity.
“Therefore, the Union government’s joint task force has advised using 500ml of normal saline before, during, or after amphotericin B infusion,” Pujari said.
The task force’s advisory brings massive relief to patients nationwide. Most doctors treating mucormycosis have been apprehensive about using conventional amphotericin (deoxycholate), citing its impact on kidneys by triggering nephrotoxicity. Instead, they have been using the extremely expensive (liposomal) formulation of the drug.
But a minimum 21-day course of the liposomal form can cost anywhere between Rs 7.5 lakh to Rs 17 lakh, depending on a patient’s body weight. Treatment course with conventional amphotericin (deoxycholate) for the same period only costs between Rs 8,000 and Rs 16,000.
“Prompt excretion of a drug by the kidneys is essential to prevent kidney toxicity. Normal saline hydration before amphotericin, and 5% dextrose mixed with amphotericin, should be the policy to prevent or reduce nephrotoxicity,” said ENT surgeon Samir Joshi.
Joshi, head of the ENT department at the state-run BJ Medical College and Sassoon General hospital, has treated about 201 patients with Covid-linked mucormycosis. “More than 85% of these patients recovered after monitored use of conventional amphotericin and carefully planned debridement (dead/infected tissue removal) surgeries,” Joshi said.
