amphotericin-b and Phlebitis

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.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Female; Health Resources; HIV Infections; Humans; Incidence; Infusions, Intravenous; Male; Meningitis, Cryptococcal; Phlebitis; Poverty Areas; Uganda

This study evaluated the effectiveness of filtering amphotericin B (ampho B) on the incidence and severity of drug-related complications. Fifteen males receiving ampho B via peripheral vein infusion participated in this randomized, double-blind study. Each patient had his dose of ampho B diluted in 500 ml of dextrose 5% in water, to which hydrocortisone 25 mg was admixed and infused over four to six hours. Eight patients had their ampho B infusions filtered through a 1 micron filter after preparation, while seven patients did not have their ampho B infusions filtered. Patients were evaluated daily for phlebitis and selected adverse effects. The two groups were comparable with regard to diagnosis, concomitant drugs, cannula type and size, vein selection, and frequency of iv site change. Four patients in each group developed phlebitis. Statistical testing using the Mann-Whitney U test revealed no difference between groups with regard to patient age, dose of ampho B, frequency and severity of phlebitis, time to onset of initial phlebitis, and frequency of adverse effects (fever, chills, headache, nausea, vomiting, and anorexia). Filtration of ampho B infusions using a 1 micron filter does not appear to decrease the incidence or severity of phlebitis and associated adverse effects.

Topics: Adult; Aged; Amphotericin B; Clinical Trials as Topic; Double-Blind Method; Filtration; Humans; Infusions, Parenteral; Male; Middle Aged; Phlebitis; Random Allocation

Cryptococcal meningitis (CM) is a common HIV-associated opportunistic-infection worldwide. Existing literature focusses on hospital-based outcomes of induction treatment. This paper reviews outpatient management in integrated primary care clinics in Yangon.. This retrospective case note review analyses a Myanmar HIV-positive patient cohort managed using ambulatory induction-phase treatment with intravenous amphotericin-B-deoxycholate (0.7-1.0 mg/kg) and oral fluconazole (800 mg orally/day).. Seventy-six patients were diagnosed between 2010 and 2017. The median age of patients diagnosed was 35 years, 63% were male and 33 (45%) were on concurrent treatment for tuberculosis. The median CD4 count was 60 at the time of diagnosis. Amphotericin-B-deoxycholate infusions precipitated 56 episodes of toxicity, namely hypokalaemia, nephrotoxicity, anaemia, febrile reactions, phlebitis, observed in 44 patients (58%). One-year survival (86%) was higher than existing hospital-based treatment studies.. Ambulation of patients in this cohort saved 1029 hospital bed days and had better survival outcomes when compared to hospital-based studies in other resource constrained settings.

Topics: Administration, Intravenous; Administration, Oral; Adolescent; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Female; Fluconazole; HIV; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Myanmar; Phlebitis; Primary Health Care; Retrospective Studies; Treatment Outcome; Young Adult

to determine the incidence of phlebitis during and after the use of peripheral intravenous catheter (PIC), and analyse the association of this complication with risk factors.. cohort study with 165 adult patients admitted to a university hospital in Porto Alegre, totalling 447 accesses, from December 2014 to February 2015. Data were collected on a daily basis and analysed by means of descriptive and analytical statistics.. The incidence of phlebitis during PIC was 7.15% and the incidence of post-infusion phlebitis was 22.9%. Phlebitis during catheter use was associated with the use of Amoxicillin + Clavulanic Acid. The grade of post-infusion phlebitis was associated with age and use of Amoxicillin + Clavulanic Acid, Tramadol Hydrochloride, and Amphotericin.. The incidence of post-infusion phlebitis proved to be an important indicator to analyse the quality of the healthcare setting.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Amphotericin B; Anti-Bacterial Agents; Catheter-Related Infections; Catheterization, Peripheral; Cross Infection; Female; Hospitals, University; Humans; Incidence; Infusions, Intravenous; Inpatients; Male; Middle Aged; Phlebitis; Tramadol; Young Adult

We report a case of fungemia caused by the yeast-form fungus Pichia ohmeriin a 59-year-old hospitalized patient. P. ohmeri was found in all of the patient's blood cultures collected on days 52, 57, 59, and 64 of his hospital stay. Intermittent fever developed on the 52nd hospital day and persisted for about 10 days. The patient had previously received intensive antimicrobial therapy for a ventriculoperitoneal shunt infection and subsequent nosocomial pneumonia. Although a central venous catheter was not used in the patient, he suffered from tender swelling of the right leg due to peripheral phlebitis at the site of insertion of a peripheral venous catheter (which had already been removed at the onset of fever), the same site from which P. ohmeri was isolated. The fungemia and phlebitis cleared following 14-day amphotericin B therapy. This case shows that P. ohmeri can be a nosocomial bloodstream pathogen associated with phlebitis.

Topics: Amphotericin B; Antifungal Agents; Cross Infection; Fungemia; Humans; Male; Middle Aged; Mycoses; Phlebitis; Pichia

Amphotericin B is the most effective agent for the majority of systemic fungal infections but often causes toxicity, and specific dosage guidelines for amphotericin B in pediatric patients are lacking. The purpose of this study was to characterize the pharmacokinetics of amphotericin B in children. Twelve patients (mean age, 6.6 years; range, 4 months to 14 years) receiving amphotericin B, 0.68 +/- 0.34 mg/kg per day (mean plus or minus standard deviation), were studied. Four to eight blood samples were collected during a 24-h period and analyzed by high-pressure liquid chromatography. The peak concentration of amphotericin B in serum was 2.9 +/- 2.8 micrograms/ml. The mean total clearance, apparent volume of distribution, and elimination half-life were 0.46 +/- 0.20 ml/min per kg, 0.76 +/- 0.52 liters/kg, and 18.1 +/- 6.6 h, respectively. Total clearance decreased with age (p less than 0.01). In children aged 8 months to 9 years, the mean total clearance was 0.57 +/- 0.15 ml/min per kg, and in children older than 9 years, it was 0.24 +/- 0.02 ml/min per kg. Interpatient variation in the clearance and volume of distribution of amphotericin B was greater than threefold and greater than eightfold, respectively. However, pharmacokinetic parameters did not change in two stable patients who were studied again. Because clearance decreased substantially with age, older children may require lower doses of amphotericin B per kilogram to decrease the potential for toxicity.

Topics: Adolescent; Amphotericin B; Child; Child, Preschool; Chromatography, High Pressure Liquid; Creatinine; Female; Half-Life; Humans; Infant; Infusions, Intravenous; Male; Phlebitis

Topics: Adult; Amphotericin B; Arteritis; Aspergillosis; Aspergillus; Autopsy; Carotid Artery Thrombosis; Humans; Immunosuppression Therapy; Infarction; Male; Muscles; Oculomotor Muscles; Optic Chiasm; Optic Nerve; Phlebitis

Topics: Amphotericin B; Extremities; Female; Humans; Maxillary Sinus; Middle Aged; Mycoses; Osteomyelitis; Phlebitis; Psychoses, Substance-Induced; Rhizopus; Sinusitis

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin

Topics: Amphotericin B; Anaphylaxis; Anemia; Anuria; Blushing; Feeding and Eating Disorders; Fever; Headache; Heart Failure; Humans; Hypokalemia; Kidney Diseases; Liver Diseases; Meningitis; Nausea; Pain; Paralysis; Paresthesia; Phlebitis; Seizures; Thrombocytopenia; Toxicology; Ventricular Fibrillation; Vertigo; Vomiting