Use of any form of Amphotericin B Alone or with Posaconazole in COVID-19 Associated Mucormycosis (CAM) at the Time of Pandemic Disaster in a Tertiary Care Teaching Hospital

Background: The recent COVID-19 wave showed a significant rise in mucormycosis, changing its prevalence, particularly in India. Sadly, the total risk of mortality due to COVID-19 associated mucormycosis (CAM) remains high. It may be better to introduce a combination of drugs rather than unacceptable poor outcomes with Amphotericin B monotherapy. Aim: The aim of this study is to assess the proportion of mucormycosis patient’s clinical outcomes with antifungal agent (Amphotericin B of any forms alone) or combination drug therapy (Amphotericin B of any form and Posaconazole). Methods: It was a retrospective cohort study conducted between April 1st, 2021 and July 31st, 2021 at the tertiary care teaching hospital All India Institutes of Medical Sciences (AIIMS), Raipur. Results: Out of 271 medical records of CAM patients, 211 records were included in the study. Among them, 46 patients (21.8%) received group 1 treatment i.e. Amphotericin only and 165 patients (78.2%) received group 2 treatment, i.e. Amphotericin B with Posaconazole. Group 2 was associated with a longer time to event, having a higher survival rate. The Hazard Ratio (HR) was 0.22 (95% CI – 0.13-0.36, p-value 0.000). result: There were a total of 271 medical records of CAM patients after crucial analysis 211 records included in the study. Among them, 46 patients (21.8%) received group 1 treatment i.e Amphotericin only and 165 patients (78.2%) received group 2 treatment ie. Amphotericin B with Posaconazole. The group 2 was associated with a longer time to event, having higher survival rate. The Hazard Ratio (HR) was 0.22 (95% CI – 0.13-0.36, p-value 0.000). Conclusion: Our findings will support the need for future studies to determine the efficacy of AMB and posaconazole combination therapy in the treatment of mucormycosis and to produce an evidence-based standard treatment regimen.