India faces antifungal drug shortage

There is no quick fix for mucormycosis. Patients undergo surgery to remove infected tissue in a procedure known as debridement. They are then treated with the antifungal medication liposomal amphotericin B to keep the infection from resurging.

As case numbers rose in May, several states reported shortages of the drug and India’s Ministry of Chemicals and Fertilizers stepped in to regulate supplies. An extra five companies were approved to produce the drug in India, and new import orders were placed.

In early June, doctors at St John’s Hospital said they were still being forced to ration doses due to erratic supplies. “It becomes a big challenge because do I under-dose 11 patients by giving one each when I’m supposed to give three to every patient? Do I select patients who get this amphotericin B? It’s been extremely tough,” said Dr. Sanjiv Lewin, the hospital’s chief of medical services.

Later that month, Lewin said supplies of the drug improved slightly but remained unpredictable. At that time, Srinivas’ sister said he had not received his dose of liposomal amphotericin B for three days.

“We have gone all over Bangalore looking for the injection, but even private hospitals have to ask for the drug from government hospitals. It’s simply not available anywhere,” Shyamala said.

The drug — expensive at about $95 a dose — is not available outside hospitals. Srinivas’ family has been relying on help from his employers and low interest loans to pay for the drug and for the private hospital fees.

Three doses are needed a day for at least 28 days, doctors say, meaning the cost of treatment could be as high as $8,000 — out of reach for many poorer Indians.

Mandaviya, India’s health minister, said when reports of mucormycosis emerged in May, India produced about 150,000 vials of amphotericin B. “The world helped us at that time … wherever in the world there was amphotericin, it was sent to us and we imported 1,300,000 vials of the drug,” Mandaviya said on Tuesday.

“I admit that it is possible that some people still did not get the drug, but the government did everything it could,” he added.

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