Can Amphotericin B Cure Black Fungus?

Dr. K. R. Meghanadh

Technically, yes, but practically, Amphotericin B alone cannot cure black fungus. Amphotericin B is one of the most effective antifungal medications for treating black fungus (mucormycosis). It works by slowing or halting the rapid progression of the infection, which, without treatment, can double in amount every few hours and become fatal within 10 to 60 days.

Why Amphotericin B Alone Cannot Cure Black Fungus?

The challenge lies in the potency of Amphotericin B. This powerful drug must be administered carefully, typically in an ICU setting, as its dosage needs to be proportional to the fungal load in the body. Unfortunately, the amount of Amphotericin B required to eliminate all the fungus is often too high for patients to tolerate safely.

To address this, treatment involves a combination of surgery and antifungal therapy. During surgery, as much of the fungus as possible is physically removed, reducing the fungal burden. This allows doctors to use a tolerable dose of Amphotericin B to manage and eventually cure the remaining infection.

Amphotericin B

Amphotericin B is derived from Amphotericin, which is produced from Streptomyces nodosus bacteria. There are various types of Amphotericin, such as Amphotericin A, B, C, and X. Amphotericin B is highly effective against fungi, while other variants, like Amphotericin C and X, can be toxic to the human body. Amphotericin, in its raw form, is harmful to the human body. So, to make it safer, Amphotericin B is extracted from Amphotericin. This process is called lyophilization.

Types of Amphotericin B

Amphotericin B comes in three main formulations, each with unique properties:

1. Amphotericin B Deoxycholate (AMBDOC)

   AMBDOC is Amphotericin B combined with deoxycholate salt. This formulation works well when the Amphotericin B used is extremely pure. It is highly effective in treating severe fungal infections.

2. Amphotericin B with  Liposomes

   In this form, Amphotericin B is combined with liposomes (lipoproteins). This formulation is less likely to cause immediate side effects because human cells cannot initially absorb it. Fungal cells have enzymes to divide amphotericin from liposomes and there by get killed. Human cells don't have this enzyme and get saved. However, residual Amphotericin B can cause some reactions in the body after acting on the fungus.

3. Amphotericin B Lipid Complex

   This variant combines Amphotericin B with fat molecules, creating an emulsion. This form stays in the bloodstream and reaches infected tissues without spreading widely in the body, leading to fewer side effects. However, it is less effective for treating tissues with minor infections.

Amphotericin B's Role in Treatment

Amphotericin B is a powerful antifungal that control black fungus. Amphotericin B in form of Amphotericin B Deoxycholate is considered the gold-standard treatment for mucormycosis. ENT doctors may start treatment immediately if black material is found in the nose, even before test results, to prevent delays as the fungus spreads rapidly.

Treatment involves surgeries to remove infected tissues and IV Amphotericin B to target vital areas. Early treatment significantly improves survival rates, reaching up to 90%. Prompt action is crucial.

Amphotericin B Dosage

The treatment usually starts with a test dosage. After that, the recommended dose is 1-2 mg per kg of body weight. The total dose depends on how much fungus remains in the body after surgery. Usually Liposomal Amphotericin B and Amphotericin B lipid complex require higher doses than AMBDOC. For example, 500 mg of liposomal Amphotericin B may be needed to match the effect of 50 mg of AMBDOC.

Side Effects of Amphotericin B

Side effects of Amphotericin B include reduced haemoglobin, kidney issues, low calcium, magnesium, and potassium levels, along with fever, chills, nausea, and diarrhoea. The purity of Amphotericin B directly influences side effects, making it critical to use high-quality Amphotericin B.

This is why it is important to perform debridement carefully. The fewer fungi remain after debridement, the better, as the dosage of Amphotericin B is directly linked to the fungi remaining in the body.

Alternative Antifungal Treatment

Amphotericin B remains the most effective antifungal for mucormycosis, though IV Isavuconazole offers similar efficacy with fewer side effects, making it ideal for patients with kidney issues. However, as a newer drug, its long-term effects are less understood, leading doctors to favor Amphotericin B due to greater familiarity. Posaconazole and oral Isavuconazole are commonly used for home therapy after discharge.

Conclusion

In conclusion, Amphotericin B plays a key role in curing black fungus. When combined with the surgeries, it provides the best possible outcomes. It's important to remember that each type of Amphotericin B has its own benefits and risks, and the treatment must start as early as possible.

Dr. K. R. Meghanadh