Abstract

An Evaluation of Risk Factors and Pharmacotherapy in Post SARS-CoV-2 (COVID-19) Rhino-Cerebral Mucormycosis Patients in a Tertiary Care Teaching Hospital in Ahmedabad

Introduction: Mucormycosis is a highly aggressive fungal infection with 0.14 cases/1000 population prevalence in India. There have been case reports of post-COVID-19 mucormycosis but the relationship is still unclear. Objectives: This study was done to identify possible risk factors and to evaluate prescribing patterns of anti-fungal agents and associated adverse drug reactions in post-COVID-19 mucormycosis patients in tertiary care hospitals in Ahmedabad.

Methods: In this prospective, observational study, patients of post-COVID-19 rhino-cerebral mucormycosis were enrolled and history-based identification of possible risk factors was done over a period of 3 months. The prescribing pattern of anti-fungal agents and supportive treatment were evaluated according to WHO core prescribing indicators. Common ADRs were recognized and their causality was established.

Results: Out of 68 enrolled patients, 61 were COVID-19 positive. 43 had mucormycosis with orbital extension and 18 had mucormycosis without orbital extension. 66.7% of patients had a history of hospitalization, 50% of patients received oxygen therapy, 61.1% patients had a history of diabetes mellitus type-2, and 66.7% patients received treatment with glucocorticoids. All patients received antibiotics, 77.8% of patients had a history of steam inhalation during COVID-19 illness. Amphotericin-B 50 mg/kg was given to 52 patients for 14 days. The average number of medicines/encounters was 9.1 and 17.6. The percentage of encounters containing antimicrobials and injections was 100%.

Conclusion: It was observed in the present study that patients who had a history of hospitalization, oxygen therapy, diabetes mellitus and steam inhalation had a high risk of post-COVID rhino-cerebral mucormycosis. Polypharmacy was observed. The highest incidence of ADR observed during the use of antifungal agents was hypokalemiao.

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