A Comparative Study of Topical Antifungal Therapy in COVID-19-Associated Mucormycosis (CAM): A New Hope?

ABSTRACT

Introduction: COVID-19-associated mucormycosis (CAM) is an ongoing epidemic that adds to COVID-19 woes in several countries. Mucormycosis is a fulminant angioinvasive fungal disease for which surgical debridement with systemic antifungal therapy is advocated. The efficacy of using topical antifungal therapy in the form of lipid-based amphotericin B gel and povidone-iodine is compared in the trial. Method(s) This is a multiarm, parallel randomized control trial. Microbiologically and histologically proven cases of mucormycosis in patients who underwent open or endoscopic surgical debridement were included in the study. The trial was conducted in the in-patient ear, nose, throat department of a tertiary care referral hospital in eastern India, All India Institute of Medical Sciences, Bhubaneswar, from May to December 2021. The postoperative cavity was treated according to the intervention arm in the form of lipid-based amphotericin B gel, povidone-iodine ointment, or saline nasal douching according to the allotted group. The aim was (1) to compare the efficacy of 0.1% w/w liposomal amphotericin B gel with 10% w/w povidone-iodine and saline nasal douching in preventing revision surgery in patients with CAM and (2) to develop the AIIMS Bhubaneswar Endoscopic Scoring System (AMESS) to quantify response to treatment. The requirement of revision surgery in postoperative cases of CAM was assessed. Result(s) Fifteen participants were analyzed in each group. The control arm's risk of revision surgery was 4.50 (95% CI, 1.16-17.44) times than the lipid-based amphotericin B gel arm and 1.50 (95% CI, 0.71-3.16) times than povidone-iodine arm. The difference was statistically significant (P=.02) for amphotericin but not for povidone-iodine. The absolute risk reduction of applying amphotericin gel is 46.7%, and number needed to treat is 2.14. Conclusion(s) Topical amphotericin B gel application in the postoperative cavity can decrease the need for revision surgery and help in early recovery. However, long-term studies with greater sample size are required to confirm our findings.