Adjunctive use of saturated solution of potassium iodide (SSKI) with liposomal amphotericin B (L-AMB) in mucormycosis achieves favorable response, shortened dose and duration of amphotericin: A retrospective study from a COVID-19 tertiary care center.

Abstract

PURPOSE:

Second wave of COVID-19 pandemic was associated with an unprecedented rise in cases of mucormycosis, treatment of which has been challenging owing to the availability and side effects associated with amphotericin.

METHODS:

All patients presenting with rhino-orbital cerebral mucormycosis (ROCM) following COVID-19 infection between April 2021 to June 2021 were included in this retrospective interventional study. Primary objective was to assess the clinical response with combination of intravenous liposomal amphotericin B (4-5 mg/kg/day) and saturated solution of potassium iodide (SSKI) given orally along with surgical debridement.

RESULTS:

Twenty-five patients of ROCM were treated with the regimen. Mean age and fasting blood sugar levels were 53.48 years and 239.64 mg/dL respectively. All patients had history of intake of steroids with a mean daily dose of 86.39 mg of prednisolone equivalent. 88% of patients had a "proven" diagnosis of mucormycosis. Cultures were positive in 52% of patients with Rhizopus arrhizus as the predominant species. The mean daily dose of amphotericin received was 268 mg/day with a mean duration of 9.52 days. Mean daily dose of SSKI was 2.57 g. 21 patients (84%) had stabilization of disease at week 8 and achieved cure at the end of treatment whereas the mortality rate was 16%. Factors that significantly affected outcome were eye and central nervous system (CNS) involvement on presentation.

CONCLUSION:

SSKI, with its remarkably low cost and safety profile, makes it a potential adjuvant drug that may help achieve the twin benefits of shortened duration and dose of LAMB.

• Authors: Sumit Mrig, Kabir Sardana, Pooja Arora, Vineet Narula, Sandeep Arora, Amrit Kapoor, Ritu Raj Baruah, Poornima Sen, Shweta Agarwal, Soumya Sachdeva, Arun Dewan, Sanjeet Panesar
• Journal: American journal of otolaryngology (Am J Otolaryngol) 2022 May-Jun Vol. 43 Issue 3 Pg. 103465 ISSN: 1532-818X [Electronic] United States
• PMID: 35429848 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Inc.

Chemical References

• Antifungal Agents
• liposomal amphotericin B
• Potassium Iodide
• Amphotericin B

Topics

• Amphotericin B (therapeutic use)
• Antifungal Agents (therapeutic use)
• COVID-19
• Eye Infections, Fungal (diagnosis, drug therapy, epidemiology)
• Humans
• Mucormycosis (diagnosis, drug therapy)
• Orbital Diseases (diagnosis)
• Pandemics
• Potassium Iodide (therapeutic use)
• Retrospective Studies
• SARS-CoV-2
• Tertiary Care Centers