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Amphotericin B toxicities among HIV infected adults with Cryptococcal Meningitis in Kiambu District Hospital

Author: A.W. Karita , D.G. Nyamu , P.N. Karimi , S.C. Gitau
Is Part Of: Pharmaceutical Journal of Kenya, Volume 23, No. 4 (2018)
Background: HIV infection is a worldwide epidemic with the highest prevalence in sub-Saharan Africa. This has increased the prevalence of cryptococcal meningitis which is a common AIDS-related opportunistic infection with a high rate of morbidity and mortality. Amphotericin B is the standard treatment for cryptococcal meningitis but its use is limited by toxicities resulting from a number of factors such as cumulative dosage and concomitant drugs. Published local studies on patterns of toxicities are scanty.Objectives: The main objective of the study was to assess toxicities associated with Amphotericin B in the management of cryptococcal meningitis among HIV infected patients aged 18 years and over in Kiambu District Hospital.Methodology: A cross- section design was used that involved review of patients’ records at Kiambu District Hospital medical records department between January 2010 to December 2014. One hundred and six files of HIV infected adults with cryptococcal meningitis and treated with amphotericin B were used. Data on amphotericin B toxicities, risk factors, and preventive strategies were extracted from the files using a predesigned semi-structured data collection form. This data was entered into Microsoft Access version 2013 to create a database and then exported to IBM Statistical Package for Social Sciences Version 22.0 for analysis. Bivariate analysis using chi-square test and logistic regression were used to determine statistical significance at 0.05. P values that were equal or less the 0.05 were considered significantResults: Prevalence of infusion-related toxicities was high at 87.7%, with fever being the most common (58.1%). The overall prevalence of nephrotoxicity was at 27.4% but principally characterized by hypokalemia (41.4%) and elevated creatinine at 58.6%. Dosing of the drug was not weight based and higher amphotericin B doses were important risk factors for toxicity (p=0.045). Prevention of toxicities associated with amphotericin B involved monitoring of serum levels of potassium (p=0.028) and creatinine (p=0.019) as well as patients hydration status(p=0.026). Monitoring of toxicity was only prevalent (70%) at the initiation of therapy but declined to less than 20% in the course of treatment.Conclusion and recommendation: Prevalence of toxicity of amphotericin B in Kiambu District Hospital was high and related to the dose given. Therefore, care should be taken when dosing the drug. In addition, frequent patient monitoring, adequate hydration, and premedication are key to preventing the toxicity and should be encouraged.
Keywords: Amphotericin B, Cryptococcal meningitis, HIV/AIDS, Toxicity
Publisher: The Pharmaceutical Society of Kenya
ISSN: 2411-6386