As cases of mucormycosis rise, cost of anti-fungal injection skyrockets 10-fold

As various states report rising cases of mucormycosis, or black fungus, in COVID-19 patients, the drug used to treat the infection is in short supply, leading to skyrocketing prices.

Relatives of patients are scrambling to source Amphotericin B injections, which is critical in the treatment of mucormycosis.

Maharashtra has so far reported more than 2,000 cases of black fungus, Gujarat around 1,200. Several dozen cases have also been reported from Uttar Pradesh, Delhi, Gurugram and Telangana. According to reports, the cost of LAB injection in these regions has shot up from ₹7,000-₹8,000 per 50mg vial to ₹70,000 to ₹80,000.

Rahul Gautam, a businessman in Delhi, recently paid ₹64,000 for a vial. He told The Federa: “My father is admitted in a private hospital in Delhi. He is suffering from mucormycosis. At the time of admission, the hospital clearly told us that they don’t have LAB injections and I have to arrange them myself.

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“For two days I could not find a single injection. Yesterday, I got a call from an anonymous number. The person on the other side told me that he had four vials but asked for Rs64,000 per vial.”

Gautam said he gave his number at various pharmacies. “I think one of them arranged the vials for me but he didn’t reveal his identity. But I instantly told him that I will buy the vials. I got four vials but I need more and I don’t know where I will get more.”

In Hyderabad, four people who illegally procured and sold LAB injection were arrested by the Hyderabad Commissioner’s Task Force (North Zone) team on Monday, The Hindu reported. They were selling each vial for ₹50,000, whereas the MRP was ₹7,858.

Hospitals and Pharmacies Out of Stock

There has been a significant increase in the number of cases of mucormycosis in COVID–19 patients during treatment in hospitals and after discharge in different parts of the country.

The most prominent reasons given by the health ministry for the increase include hyperglycaemia due to uncontrolled pre-existing diabetes, rampant overuse and irrational use of steroids in the management of COVID–19 and new-onset diabetes due to steroid overuse or severe cases of COVID–19.

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The health ministry has advised the use of LAB injections to treat infection. An initial dose of 5mg/kg body weight (10 mg/kg body weight in case of CNS involvement) is used for the treatment. Each vial contains 50mg. So a single patient needs hundreds of doses of LAB.

But even big hospitals like Apollo and Sir Ganga Ram in Delhi have run out of injections. Reports of shortages are also coming from Gujarat, UP, MP, Maharashtra, Karnataka, Haryana and Telangana.

Dr Amit Kishore, an ENT surgeon in Apollo Hospital in Indraprastha Delhi, told The Federal, “Usually the demand for LAB is not so much, so the supply is also less. But the cases are increasing at a very rapid pace. I have treated 10 patients in the last two days. Usually, we get one case of black fungal infection in three-four months.”

“Out of all 10, five underwent surgery. I have performed sinus surgery on four and one patient underwent sinus and eye surgery. The patient’s eye had to be removed. Due to this infection, the tissue gets damaged and blackens. To treat the tissue, we need LAB injections. One patient needs nearly 100-1,000 vials of LAB,” added Kishore.

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Dr Ajay Swaroop, chairman of the ENT Department of Sir Ganga Ram Hospital, told NDTV, “In 35 years of my career, I have never seen so many cases of mucormycosis. Now we are seeing 20-25 cases every day. Earlier, we used to see only three-four cases of this fungal infection in six months. We are hearing about drug shortage in pharmacies across the city. We want to discharge patients and they may need the drug once they are at home. We are concerned whether people will be able to get it at the chemist shop near their homes.”

Pharmacies too are reporting shortages. “We have no stock of LAB. We had a few, but we sold them. People reach out to us but we have to send them back. We are trying to get fresh stock but the distributors are saying that they need some time for that,” a medical shopkeeper told The Federal.

“We don’t usually keep LAB injections. The demand is very low. It is now that the demand has suddenly risen. Earlier, we were getting calls for Remdesivir, now we are getting calls for LAB,” Preetam Singh from Live Aid Medicines in Delhi told The Federal.

Pharmacies and chemists can sell LAB but with prescription. Deputy Commissioner of Faridabad in Haryana, Yashpal Yadav, tweeted on Monday: “No chemist shop will sell steroids of any kind without proper prescription to avoid black fungus disease. No sale of any steroids without a prescription… action to the tune of suspending the licence will be taken if instructions are not followed.”

There are demands that stocks should now go directly to hospitals to prevent black marketing. Dr Lokesh Kharab, an ENT specialist, said: “The Amphotericin B drug is very complicated. There are many types of Amphotericin B available in the market, which start from ₹400 and go to ₹8,000. But to treat mucormycosis, we need ‘Liposomal’ Amphotericin B, which costs nearly ₹7,000-₹8,000.”

“LAB is used to treat the highest level of fungal infections like mucormycosis. We experience normal fungal infection in summers, which is treated by Fungizone Amphotericin B that is found in beauty products as well. But at the current point, to stop the black marketing of the product, the supplies from manufacturers should be directly given to hospitals treating this,” added Kharab.

Production Ramped Up

The central government has released a statement asking companies involved in manufacturing LAB to ramp up the production. The companies, however, are struggling to keep up with the demand.

Industry sources told MoneyControl that it would take at least 15-30 days for new stocks to hit the market, as the drug is complex to manufacture and would require a certain number of days of sterility data before the batch is released.