COVID 19 & MUCORMYCOSIS

MUCORMYCOSIS TREATMENT PROTOCOL or PREFERRED PRACTISE PATTERN

Suspected OR confirmed mucormycosis

Clinical findings:- 

• facial swelling, periorbital swelling, severe headache, nasal blockage 
• intraoral pus discharge, gingival abscess, teeth mobility 

History taking:- 

• Covid history: steroid therapy, other medication, hospital stay 
• Known medical history: DM, renal failure, immunocompromised patient, malignancy  

Investigation:- 

• Radiological : CT PNS or 3D CT Face, MRI 
• Blood investigation: CBC, CRP, HbA1c, Renal profile

Radiological findings:- 

• Early stage: sinusitis 
• Intermediate stage: Bony erosion in maxilla 
• Aggressive stage: involvement of orbit and brain 

A. Early stage (only sinus are involved no bony change) 

• Excisional biopsy (deep bone) + Sinus lining 
• FESS 

B. Confirmed or late stage (bony erosion) 

• Debridement and curettage till healthy bone, 
• orbital exenteration if indicated after ophthalmologist / occuloplasty surgeon opinion 
• FESS

Test sampling: 

• Bacterial or fungal cultural and sensitivity 
• Histopathological investigation

Confirmed mucormycosis

Antifungal medication For 14 to 21 days

Inj Amphotericin B (1.0-1.5 mg/kg/day) 

Inj Liposomal Amphotericin B (5-10 mg/kg/day)  

Tab Posaconazole GR 100 mg (step down or adjutant therapy)  for 45 days

First day -300 mg BD  

Other days- 300 mg OD

Alternate day perform - S. Creatinine - S. Electrolyte To avoid Nephrotoxicity and hypokalaemia

Regular follow-up (CT PNS every 15 days to 1 month)

Amphotericin B administration protocol

Amphotericin B  1.0-1.5 mg/kg/day  

Liposomal Amphotericin B  5-10 mg/kg/day 

FOR 14 to 21 days depending on severity

Pre-hydration:-

• 500ml Normal saline 2 hr before infusion Amphotericin B
• To reduces the risk of renal toxicity and hypokalaemia :- 500ml
• Normal Saline + 1 Amp (20mmol) KCL

Hydration:-

• Dilution: 1mg in 10 ml
• Always use 5% or 10% dextrose
• Avoid Normal saline
• 500 mL NS IV given pre infusion
• If fluid overloaded, use 250 mL pre/post or skip post-hydration
• If hyperchloremic, may use normosol instead of NS
• Protect from light during administration

for details of treatment protocol: 
CLICK HERE

Treatment Protocol For Mucormycosis In Adult Patients - By Expert Committee of Civil Hospital, Ahmedabad