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

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number558
JournalBMC infectious diseases
Volume19
Issue number1
DOIs
StatePublished - Jun 26 2019

Bibliographical note

Funding Information:
This work received no specific funding. However, the parent study (ASTRO-CM) was supported by the Fogarty International Center and National Institute of Neurologic Disorders and Stroke (R01NS086312, K01TW010268). The funders of ASTRO-CM were not involved in study design, data collection, analysis, interpretation, writing report and the decision to submit the article for publication. DBM and RK are currently supported through the DELTAS Africa Initiative grant # DEL-15-011 to THRiVE-2, from Wellcome Trust grant # 107742/Z/15/Z and the UK government.

Keywords

  • Amphotericin B
  • Cryptococcal infection
  • HIV
  • Nursing
  • Phlebitis
  • Sub-Saharan Africa
  • Thrombophlebitis

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