New Delhi: The Directorate General of Health Services (DGHS) issued guidelines for the management of Mucormycosis/black fungus disease in children below 18 years.
The government advised that one should now wait for culture results to initiate therapy as mucormycosis is an emergency.
According to the government, Mucormycosis or black fungus is a complication caused by a fungal infection. People catch mucormycosis by coming in contact with the fungal spores in the environment.
It can also develop on the skin after the fungus enters the skin through a cut, scrape, burn, or other types of skin trauma. What is more worrying is that the fungal complication is being detected in several COVID-19 patients.
On Mucormycosis treatment the DGHS advised that closely monitor kidney function and electrolytes during treatment. Reconstitute in water for injection, and dilute in 5% dextrose start with test dose: 1 mg IV infusion over 20-30 min.
Loading dose: 0.25–0.5 mg/kg IV infused over 2-6 hours; gradually increase by 0.25 mg-increments/day to reach maintenance dose: 1–1.5 mg/kg/day.
Liposomal Amphotericin B or Amphotericin lipid complex: 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% 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)
The DGHS in its guideline stated that “Continue till a favorable response is achieved which may take 3-6 weeks following which step down to oral Posaconazole (delayed-release tablets, children equal or more than 3 years and adolescents equal or less than 17 years: 5-7 mg/kg/dose twice daily on day 1, followed by 5 to 7 mg/kg/dose daily) or Isavuconazole may have to be taken for a prolonged period as per the advice of a pediatrician.
Isavuconazole approved below 18 years of age, however, if required to be given, the dose for weight more than 30kg: 200 mg 1 tablet 3 times daily for 2 days followed by 200 mg daily, less than 30kg: half the dose for more than 30 kg children.
Posaconazole should be given as salvage therapy in cases who cannot be given Amphotericin B.
Maximum dose 800 mg/day, for those children and adolescents with body weights more than 34 kg the dose is 200 mg/dose 3 times daily (maximum 200 mg 4 times a day).
Injection IV is for Children less than 11 years: Loading dose: 7-12 mg/kg/dose IV twice on the first day and maintenance dose: 7-12 mg/kg IV once a day, starting on the second day (max: 300 mg/dose)
Adolescents: 300 mg IV twice on the first day and maintenance dose 300 mg IV once a day, starting on the second day. Oral delayed-release tablets (100 mg) and Oral Suspension (for infants and smaller children) to be administered with fatty food:
Oral delayed-release tablets: Children 7 to 12 years – Initial dose should be 200 mg/dose thrice daily and maximum dose can be 800 mg/day
Adolescents: 300 mg/dose twice on day 1, followed by 300 mg/dose once daily.
Oral suspension (for infants and children) as syrup in a strength of 40 mg/ml. The recommended dose for children with a bodyweight less than 34 kg is 4.5 to 6 mg/kg/dose 4 times daily.