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

Pugazhenthan Thangaraju; Ripudaman Arora; Nitin M Nagarkar; Pankaj Kumar Kannauje; Rupa Mehta; Hemasri Velmurugan; Muthathal Subramanian

doi:10.2174/0127724344355666250513101536

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

Recent Adv Antiinfect Drug Discov. 2025 May 15. doi: 10.2174/0127724344355666250513101536. Online ahead of print.

Authors

Pugazhenthan Thangaraju¹, Ripudaman Arora², Nitin M Nagarkar³, Pankaj Kumar Kannauje⁴, Rupa Mehta², Hemasri Velmurugan¹, Muthathal Subramanian⁵

Affiliations

¹ Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh, India.
² Department of ENT, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh, India.
³ Department of ENT, SRM Medical College Hospital and Research Centre, SRM Nagar, Potheri, Chengalpattu, Tamil Nadu, India.
⁴ Department of Medicine, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh, India.
⁵ Department of Community Medicine, Karpagam Faculty of Medical Sciences & Research, Coimbatore, Tamilnadu, India.

PMID: 40377153
DOI: 10.2174/0127724344355666250513101536

Abstract

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).

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.

Keywords: Amphotericin B; COVID-19-associated mucormycosis; SARS-CoV-2; antifungal; black fungus.; posaconazole.