COVID treatment guidelines may contribute to the increase of black mold in India

One of the recent alarming consequences of COVID-19 in India is the emergence of zygomycosis and co-infection with other fungi.

Media coverage Use black, white, and yellow fungi to refer to mycosis, aspergillosis, candidiasis, and cryptococcosis. Together, they are called invasive fungal infections and usually infect people with weakened immune systems or damaged tissues.

About 12,000 cases of mucormycosis have been reported. Sideways The country of the last few months.

these are Is said to have been caused With steroid misuse Antibiotics A large number of diabetic patients with poor control of COVID treatment and tissue damage (which undermines our ability to combat these fungal infections).

Zygomycosis Most commonly appear It infects the nose and sinuses, which can spread to the eyes, lungs, and brain. It also affects other organs, including the skin.

Large scale Lack The use of amphotericin B, the main treatment for zygomycosis, has been reported.Citizens had to confront Social media And court Procure medicine.

The central government has licensed five companies to manufacture the drug, in addition to the six that have already done so.

Black mold (mucormycosis) remedy #Amphotericin B The shortage of

Within three days, in addition to the existing six pharmaceutical companies, five more pharmaceutical companies received new drug approvals in India. (1/2) pic.twitter.com/hm9KiZgxr4

–Mansukhmandviya (@mansukhmandviya) May 20, 2021

Could the situation be avoided? Perhaps the government has issued clear guidelines on the use of steroids and antibiotics in the treatment of COVID-19, taking into account recent evidence.

What I knew before the second wave

More than last year, COVID-19-related invasive fungal infections have been reported from several countries. In India, it was reported early. April last year, During the first wave.

These infections also report During previous epidemics such as SARS in 2003.

Is infection Often deadly. Deaths from fungal infections in previous coronavirus epidemics such as SARS 25% -73%..

Indian Antibiotic Guidelines

Two latest versions of India’s COVID treatment guidelines (June 27, 2020 And May 24, 2021) Naturally, antibiotics should not be prescribed on a daily basis.

Instead, they urge doctors to consider “empirical” antibiotic therapy according to “local antibiotics” if the COVID patient has a moderate secondary infection. It means making a diagnosis based on what is stated in the literature as the most likely pathogen (or insect) that is causing the infection. Antibiogram They are sent to the hospital on a regular basis to explain the current infections circulating in the area and which antibiotics are effective against them.

For severe secondary infections, the guidelines recommend performing blood cultures to see which antibiotics work. Ideally, before starting the dosing.

The empirical approach works only if the majority of COVID institutions treating moderate cases have access to local antibiograms. Otherwise, doctors will usually prescribe broad spectrum antibiotics. Widespread antibiotics kill a variety of insects, not specific ones. This is dangerous because it can also kill good bugs that are used to fight the following: Fungal infection..

Ah Research Of the 10 hospitals in India, 74% of patients with secondary infections in the first wave received antibiotics World Health Organization Stated that it should be used sparingly, and an additional 9% were given non-recommended antibiotics.

The guidelines should advise the same procedure for moderate and severe cases. This means that blood cultures should be performed before starting antibiotic treatment to ensure that the antibiotics work and do not cause secondary fungal infections.

Steroid dose is too high

One of the COVID treatments recommended by the National Institutes of Health is 32 mg daily The steroid methylprednisolone.

March 2020, India Guidelines For patients with severe symptoms, 1-2 mg of metiprednisolone per kg of body weight is recommended (70-140 mg for 70 kg people).

this is. .. ..was Updated June 2020 Low doses of methylprednisolone (35-70 mg / day for 70 kg people) for 3 days in moderate cases, 5-7 original recommended doses (70-140 mg / day for 70 kg people) in severe cases Use for days.

Latest guidelines April 2021 We do not change the daily dose, but we recommend an extension of the treatment period of 5-10 days, both in moderate and severe cases.

Nonetheless, India’s recommendations work in a wide range, from moderate to severe categories, from a low of about 35 mg to a high of 140 mg (70 kg people). This is very different from the US recommended 32 mg (total daily dose).

Government of India spokesman The increase in fungal infections is due to the fact that national doctors may have used steroids unreasonably.

However, given the government’s own guidelines, Use of steroids It is much higher than in other countries, so it is necessary to analyze whether this contributes to a significant increase in population. Fungal infection..

The results of these findings will have a significant impact on India’s pandemic management.

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