New guidelines for the treatment of black fungus in kids

The Center has issued a new set of rules for the treatment of Mucormycosis or black fungus disease in kids under the age of 18 years.

According to the guidelines that the Director-General of Health Services (DGHC) under the Union Health Ministry has issued, Black Fungus is a severe fungal infection noticed in patients suffering from immunosuppression, poorly controlled diabetes mellitus, misuse or excessive use of steroids, cancer, organ or stem cell transplantation and those admitted in ICU for a long period of time.

As per the guidelines, DGHC has ordered to start treating the patients and not wait for culture results as it is an emergency. The DGHC stated in the guideline, “Early complete surgical debridement is the cornerstone of treatment, and may be repeated as required.”

As per the guidelines, “Conventional Amphotericin B as a prolonged IV infusion through a central venous catheter or PICC; closely monitor kidney function and electrolytes during treatment. Reconstitute in water for injection, and dilute in 5 percent dextrose (do not use normal saline/Ringer’s lactate, start with test dose: 1 mg IV infusion over 20-30 minutes. Loading dose: 0.25-0.5 mg/kg IV infused over 2-6 hours; gradually increase by 0.25 mg increment/day to reach maintenance dose: 1-1.5 mg/kg/day.”

It further added, “Liposomal Amphotericin B or Amphotericin lipid complex, if available; prolonged infusion over 2-3 hours through a central venous catheter or PICC and closely monitoring KFT and electrolytes. Reconstitute in water for injection, and dilute in 5 percent dextrose (do not use normal saline/Ringer’s lactate); start full dose from the first day; 5 mg/kg/day (10 mg/kg/day in case of CNS involvement)”.

Patients who cannot receive Amphotericin B should have saliva therapy. It concluded that kids below 11 years of age should receive 7-12 mg/kg/dose IV two times on the first day and a maintenance dose 7-12 mg/kg IV one time a day, beginning from the second day.