Management of Amphotericin-Induced Phlebitis among HIV Patients with Cryptococcal Meningitis in a Resource Limited Setting: A Prospective Cohort Study

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dc.contributor.authorAhimbisibwe, Cynthia
dc.contributor.authorKwizera, Richard
dc.contributor.authorNdyetukira, Jane Frances
dc.contributor.authorKugonza, Florence
dc.contributor.authorHullsiek, Kathy Huppler
dc.contributor.authorWilliams, Darlisha A.
dc.contributor.authorRhein, Joshua
dc.contributor.authorBoulware, David R.
dc.contributor.authorMeya, David B.
dc.date.accessioned2022-08-19T14:55:04Z
dc.date.available2022-08-19T14:55:04Z
dc.date.issued2019
dc.description.abstractAmphotericin-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.en_US
dc.identifier.citationAhimbisibwe, C., Kwizera, R., Ndyetukira, J. F., Kugonza, F., Sadiq, A., Hullsiek, K. H., ... & Meya, D. B. (2019). Management of amphotericin-induced phlebitis among HIV patients with cryptococcal meningitis in a resource-limited setting: a prospective cohort study. BMC infectious diseases, 19(1), 1-6.https://doi.org/10.1186/s12879-019-4209-7en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/4328
dc.language.isoenen_US
dc.publisherBMC infectious diseasesen_US
dc.subjectPhlebitis, Thrombophlebitis, Amphotericin B, Cryptococcal infection, HIV, Nursing, Sub-Saharan Africaen_US
dc.titleManagement of Amphotericin-Induced Phlebitis among HIV Patients with Cryptococcal Meningitis in a Resource Limited Setting: A Prospective Cohort Studyen_US
dc.typeArticleen_US
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