Limited supply of antifungal drugs puts private docs in spot

HYDERABAD:  Restricted supply of antifungal drugs and the complicated procedures for getting them from government agencies have put private ENT hospitals that treat black fungus cases in a tight spot.

Only five vials of 50 mg per patient per day of amphotericin B injections are allotted for private hospitals by the state government. To get this medicine, it requires an endoscopy report, medical papers for treatment progress and other social details of the patients.

ENT doctors at private hospitals who are treating them say that the government supplying medicines was a good step but the paper work was taking a lot of their time.

Every day they have to update the status of the patient and once cleared, patients’ relatives have to queue at stockists for the five vials per day.

Dr Srinivas Kishore, a senior ENT surgeon, told this newspaper "Each patient will require between 30 to 40 vials in one week. When we are running around for five vials per day, it can be administered only once. Time gap between infusions of medicine increases and that challenges the treatment as it will not be effective."

Most patients have undergone surgery with removal of fungus from the nose and the eye region. To ensure that it gets completely eradicated from the body, amphotericin B is the first line of drug which has to be administered.

To manage the gap, patients are being administered alternative antifungal oral medicines but that is a challenge. A senior ENT specialist on condition of anonymity said, "Oral medicines work when the patient goes home after the first line of treatment of complete eradication of the fungus from the body. As there are not sufficient stocks available, we have to give medicines but whether it will help or not, we are not sure."

Other doctors in private hospitals have been instructed by the managements that till there is sufficient supply of medicines, more patients must not be admitted. A senior doctor at a private hospital explained, "We have 30 patients and of them three have fungus invasion in the brain. All of them have undergone surgery and now relatives are running up and down for medicines. We are not taking in more patients as it is very stressful. The government must provide complete stock for one patient in the coming days as that will ensure effective treatment and early discharge from the hospital."

Those who have undergone brain surgery are now having other complications and they require monitoring by a team of specialists. Doctors say that out of 10 patients, they have one patient with invasion in the brain. There are also side-effects of amphotericin on the kidney and heart and it requires monitoring of these patients by specialists too.

For this reason, there is a team of doctors and that is adding to the financial stress of the patients.

According to Dr Janardhan Rao Jagini, head of the department and consultant ENT surgeon at KIMS Hospital, "Most of the patients coming to hospitals with black fungus have been given steroids, antibiotics, Remdesiver, Tocilizumab and their immunity is compromised. Relatives are extremely stressed socially and financially as they have been attending to patients during their Covid-19 treatment and now due to black fungus. It is adding to their stress levels." ENT surgeons appeal that once sufficient stocks are available in the market there must be a better mechanism in place for dispensing maximum medicines.