Amphotericin B Toxicities among HIV Infected Adults with Cryptococcal Meningitis in Kiambu District Hospital
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Date
2018
Authors
Karita, A.W
Nyamu, D.G
Karimi, P.N
Gitau, S.C
Journal Title
Journal ISSN
Volume Title
Publisher
Pharmaceutical Society of Kenya
Abstract
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 significant
Results: 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
A.W. Karita , D.G. Nyamu , P.N. Karimi , S.C. Gitau
University of Nairobi, College of Health Sciences, Department of Pharmaceutics & Pharmacy
Practice, P.O Box 19676-00202, Nairobi, Kenya. Emails- P.N. Karimi- ndirang@yahoo.com,
D.G.Nyamu-dgnyamu@gamil.com, A.W Karita-aggienjane@gmail.com.
Kenyatta University, Department of Pharmacy and complementary/Alternative medicine, P.O Box
43844-00100, Nairobi, Kenya, email—gitaus2009@gmail.com
*Corresponding author
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(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.
Description
Article
Keywords
Amphotericin B, Cryptococcal meningitis, HIV/ AIDS, Toxicity
Citation
Karita, A. W., Nyamu, D. G., Karimi, P. N., & Gitau, S. C. Amphotericin B toxicities among HIV infected adults with Cryptococcal Meningitis in Kiambu District Hospital. Pharmaceutical, 18(35), 36-65.