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, 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

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. ClincalTrials.gov : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.

Keywords: Amphotericin B; Cryptococcal infection; HIV; Nursing; Phlebitis; Sub-Saharan Africa; Thrombophlebitis.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Durski KN, Kuntz KM, Yasukawa K, Virnig BA, Meya DB, Boulware DR. Cost-effective diagnostic checklists for meningitis in resource-limited settings. J Acquir Immune Defic Syndr. 2013;63(3):e101–e108. doi: 10.1097/QAI.0b013e31828e1e56.
    1. Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, Denning DW, Loyse A, Boulware DR. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis. 2017;17(8):873–881. doi: 10.1016/S1473-3099(17)30243-8.
    1. Parkes-Ratanshi R, Achan B, Kwizera R, Kambugu A, Meya D, Denning D. Cryptococcal disease and the burden of other fungal diseases in Uganda; where are the knowledge gaps and how can we fill them? Mycoses. 2015;58(S5):85–93. doi: 10.1111/myc.12387.
    1. Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children [].
    1. Enoch D, Ludlam H, Brown N. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol. 2006;55(7):809–818. doi: 10.1099/jmm.0.46548-0.
    1. Abassi M, Boulware DR, Rhein J. Cryptococcal meningitis: diagnosis and management update. Curr Trop Med Rep. 2015;2(2):90–99. doi: 10.1007/s40475-015-0046-y.
    1. Ndyetukira JF, Kwizera R, Kugonza F, Ahimbisibwe C, Namujju C, Sadiq A, Namudde A, Williams D, Abassi M, Rhein J, et al. The conundrum of clinical trials and standard of care in sub-Saharan Africa – the research nurse perspective. J Res Nurs. 2019. 10.1177/1744987118824625.
    1. Rhein J, Morawski BM, Hullsiek KH, Nabeta HW, Kiggundu R, Tugume L, Musubire A, Akampurira A, Smith KD, Alhadab A. Efficacy of adjunctive sertraline for the treatment of HIV-associated cryptococcal meningitis: an open-label dose-ranging study. Lancet Infect Dis. 2016;16(7):809–818. doi: 10.1016/S1473-3099(16)00074-8.
    1. Boulware DR, Rolfes MA, Rajasingham R, von Hohenberg M, Qin Z, Taseera K, Schutz C, Kwizera R, Butler EK, Meintjes G, et al. Multisite validation of cryptococcal antigen lateral flow assay and quantification by laser thermal contrast. Emerg Infect Dis. 2014;20(1):45–53. doi: 10.3201/eid2001.130906.
    1. Dyal J, Akampurira A, Rhein J, Morawski BM, Kiggundu R, Nabeta HW, Musubire AK, Bahr NC, Williams DA, Bicanic T, et al. Reproducibility of CSF quantitative culture methods for estimating rate of clearance in cryptococcal meningitis. Med Mycol. 2016;54(4):361–369. doi: 10.1093/mmy/myv104.
    1. Khoo S, Bond J, Denning DW. Administering amphotericin B—a practical approach. J Antimicrob Chemother. 1994;33(2):203–213. doi: 10.1093/jac/33.2.203.
    1. Maki DG, Ringer M. Risk factors for infusion-related phlebitis with small peripheral venous catheters: a randomized controlled trial. Ann Intern Med. 1991;114(10):845–854. doi: 10.7326/0003-4819-114-10-845.
    1. Urbanetto JS, Peixoto CG, May TA. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal. Rev Lat-Am Enfermagem. 2016;24:e2746. doi: 10.1590/1518-8345.0604.2746.
    1. Annisa F, Nurhaeni N, Wanda D. Warm water compress as an alternative for decreasing the degree of phlebitis. Comprehensive Child Adolesc Nurs. 2017;40(sup1):107–113. doi: 10.1080/24694193.2017.1386978.
    1. Molloy SF, Kanyama C, Heyderman RS, Loyse A, Kouanfack C, Chanda D, Mfinanga S, Temfack E, Lakhi S, Lesikari S, et al. Antifungal combinations for treatment of cryptococcal meningitis in Africa. N Engl J Med. 2018;378(11):1004–1017. doi: 10.1056/NEJMoa1710922.
    1. Jarvis JN, Leeme TB, Molefi M, Chofle AA, Bidwell G, Tsholo K, Tlhako N, Mawoko N, Patel RKK, Tenforde MW, et al. Short course high-dose liposomal amphotericin B for HIV-associated Cryptococcal meningitis: a phase-II randomized controlled trial. Clin Infect Dis. 2018;68(3):393–401. doi: 10.1093/cid/ciy515.
    1. Lawrence DS, Youssouf N, Molloy SF, Alanio A, Alufandika M, Boulware DR, Boyer-Chammard T, Chen T, Dromer F, Hlupeni A, et al. AMBIsome therapy induction OptimisatioN (AMBITION): high dose AmBisome for Cryptococcal meningitis induction therapy in sub-Saharan Africa: study protocol for a phase 3 randomised controlled non-inferiority trial. Trials. 2018;19(1):649. doi: 10.1186/s13063-018-3026-4.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi