Management of amphotericin-induced phlebitis among HIV patients with cryptococcal meningitis in a resource-limited setting: a prospective cohort study.
AIDS-Related Opportunistic Infections
/ drug therapy
Adult
Amphotericin B
/ administration & dosage
Antifungal Agents
/ administration & dosage
Deoxycholic Acid
/ administration & dosage
Drug Combinations
Female
HIV Infections
/ complications
Health Resources
/ economics
Humans
Incidence
Infusions, Intravenous
Male
Meningitis, Cryptococcal
/ complications
Phlebitis
/ chemically induced
Poverty Areas
Uganda
/ epidemiology
Amphotericin B
Cryptococcal infection
HIV
Nursing
Phlebitis
Sub-Saharan Africa
Thrombophlebitis
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
26 Jun 2019
26 Jun 2019
Historique:
received:
24
04
2019
accepted:
19
06
2019
entrez:
28
6
2019
pubmed:
28
6
2019
medline:
21
8
2019
Statut:
epublish
Résumé
Amphotericin-induced phlebitis is a common infusion-related reaction in patients managed for cryptococcal meningitis. High-quality nursing care is critical component to successful cryptococcosis treatment. We highlight the magnitude and main approaches in the management of amphotericin-induced phlebitis and the challenges faced in resource-limited settings. We prospectively determined the incidence of amphotericin-induced phlebitis during clinical trials in Kampala, Uganda from 2013 to 2018. We relate practical strategies and challenges faced in clinical management of phlebitis. Overall, 696 participants were diagnosed with HIV-related cryptococcal meningitis. Participants received 7-14 doses of intravenous (IV) amphotericin B deoxycholate 0.7-1.0 mg/kg/day for induction therapy through peripheral IV lines at a concentration of 0.1 mg/mL in 5% dextrose. Overall, 18% (125/696) developed amphotericin-induced phlebitis. We used four strategies to minimize/prevent the occurrence of phlebitis. First, after every dose of amphotericin, we gave one liter of intravenous normal saline. Second, we rotated IV catheters every three days. Third, we infused IV amphotericin over 4 h. Finally, early ambulation was encouraged to minimize phlebitis. To alleviate phlebitis symptoms, warm compresses were used. In severe cases, treatment included topical diclofenac gel and oral anti-inflammatory medicines. Antibiotics were used only when definite signs of infection developed. Patient/caregivers' education was vital in implementing these management strategies. Major challenges included implementing these interventions in participants with altered mental status and limited access to topical and oral anti-inflammatory medicines in resource-limited settings. Amphotericin-induced phlebitis is common with amphotericin, yet phlebitis is a preventable complication even in resource-limited settings. The ASTRO-CM trial was registered prospectively. ClincalTrials.gov : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.
Sections du résumé
BACKGROUND
BACKGROUND
Amphotericin-induced phlebitis is a common infusion-related reaction in patients managed for cryptococcal meningitis. High-quality nursing care is critical component to successful cryptococcosis treatment. We highlight the magnitude and main approaches in the management of amphotericin-induced phlebitis and the challenges faced in resource-limited settings.
METHODS
METHODS
We prospectively determined the incidence of amphotericin-induced phlebitis during clinical trials in Kampala, Uganda from 2013 to 2018. We relate practical strategies and challenges faced in clinical management of phlebitis.
RESULTS
RESULTS
Overall, 696 participants were diagnosed with HIV-related cryptococcal meningitis. Participants received 7-14 doses of intravenous (IV) amphotericin B deoxycholate 0.7-1.0 mg/kg/day for induction therapy through peripheral IV lines at a concentration of 0.1 mg/mL in 5% dextrose. Overall, 18% (125/696) developed amphotericin-induced phlebitis. We used four strategies to minimize/prevent the occurrence of phlebitis. First, after every dose of amphotericin, we gave one liter of intravenous normal saline. Second, we rotated IV catheters every three days. Third, we infused IV amphotericin over 4 h. Finally, early ambulation was encouraged to minimize phlebitis. To alleviate phlebitis symptoms, warm compresses were used. In severe cases, treatment included topical diclofenac gel and oral anti-inflammatory medicines. Antibiotics were used only when definite signs of infection developed. Patient/caregivers' education was vital in implementing these management strategies. Major challenges included implementing these interventions in participants with altered mental status and limited access to topical and oral anti-inflammatory medicines in resource-limited settings.
CONCLUSIONS
CONCLUSIONS
Amphotericin-induced phlebitis is common with amphotericin, yet phlebitis is a preventable complication even in resource-limited settings.
TRIAL REGISTRATION
BACKGROUND
The ASTRO-CM trial was registered prospectively. ClincalTrials.gov : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.
Identifiants
pubmed: 31242860
doi: 10.1186/s12879-019-4209-7
pii: 10.1186/s12879-019-4209-7
pmc: PMC6595678
doi:
Substances chimiques
Antifungal Agents
0
Drug Combinations
0
Deoxycholic Acid
005990WHZZ
Amphotericin B
7XU7A7DROE
amphotericin B, deoxycholate drug combination
87687-70-5
Banques de données
ClinicalTrials.gov
['NCT01802385']
Types de publication
Clinical Trial
Clinical Trial, Phase II
Clinical Trial, Phase III
Journal Article
Multicenter Study
Observational Study
Randomized Controlled Trial
Langues
eng
Pagination
558Subventions
Organisme : Medical Research Council
ID : MR/M007413/1
Pays : United Kingdom
Organisme : NINDS NIH HHS
ID : R01 NS086312
Pays : United States
Organisme : NINDS NIH HHS
ID : R01NS086312
Pays : United States
Organisme : FIC NIH HHS
ID : K01 TW010268
Pays : United States
Organisme : FIC NIH HHS
ID : K01TW010268
Pays : United States
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