Management of amphotericin-induced phlebitis among HIV patients with cryptococcal meningitis in a resource-limited setting: A prospective cohort study

Cynthia Ahimbisibwe, Richard Kwizera, Jane Frances Ndyetukira, Florence Kugonza, Alisat Sadiq, Kathy Huppler Hullsiek, Darlisha A. Williams, Joshua Rhein, David R. Boulware, David B. Meya

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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: 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: 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: Amphotericin-induced phlebitis is common with amphotericin, yet phlebitis is a preventable complication even in resource-limited settings.

TRIAL REGISTRATION: The ASTRO-CM trial was registered prospectively. : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.

Original languageEnglish (US)
Article number558
JournalBMC infectious diseases
Issue number1
StatePublished - Jun 26 2019

Bibliographical note

Publisher Copyright:
© 2019 The Author(s).


  • Amphotericin B
  • Cryptococcal infection
  • HIV
  • Nursing
  • Phlebitis
  • Sub-Saharan Africa
  • Thrombophlebitis
  • Humans
  • Uganda/epidemiology
  • Male
  • AIDS-Related Opportunistic Infections/drug therapy
  • Amphotericin B/administration & dosage
  • Incidence
  • HIV Infections/complications
  • Deoxycholic Acid/administration & dosage
  • Meningitis, Cryptococcal/complications
  • Adult
  • Female
  • Health Resources/economics
  • Infusions, Intravenous
  • Poverty Areas
  • Phlebitis/chemically induced
  • Antifungal Agents/administration & dosage
  • Drug Combinations

PubMed: MeSH publication types

  • Clinical Trial
  • Observational Study
  • Randomized Controlled Trial
  • Multicenter Study
  • Clinical Trial, Phase II
  • Clinical Trial, Phase III
  • Journal Article


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