Background: In Uganda where the burden of HIV-associated cryptococcal meningitis is high, conventional amphotericin B deoxycholate has been standard to manage patients with cryptococcal meningitis in research settings. However, liposomal amphotericin B (AmBisome) is now available via the efforts of UNITAID. We sought to describe our nursing experience using AmBisome within a clinical trial for cryptococcal meningitis.
Methods: We describe the experience of using single-dose 10mg/kg liposomal amphotericin B from the perspective of a research nurse in Uganda. Second, we described the process of preparing and administering amphotericin. Third, we assessed the nursing time required for the administration of daily amphotericin B versus single-dose liposomal amphotericin. Fourth, we discuss the major challenges faced while using liposomal amphotericin B.
Results: We provide estimates for the nursing time required for reconstituting, filtering, diluting and administering liposomal amphotericin B and a visual aid for nursing tasks. Based on five trained nurses, the process of reconstitution and filtration lasts an average of 52 minutes (Range: 40 to 60 minutes), to reconstitute a mean of 11 (range: 8 to 15) 50mg vials (median weight 55kg). Overall, less nursing time was required for single-dose administration than for daily amphotericin B dosing. From a nursing perspective, liposomal amphotericin B was preferable to amphotericin B deoxycholate due to its reduced infusion reactions and other toxicities.
Conclusions: Single-dose liposomal amphotericin B is a better alternative to daily amphotericin B. In addition to less toxicity, nosocomial infections, reduced hospital stay, and the potential for lower hospitalisation costs, the nursing implications should not be discounted. Quality nursing care is a finite resource in low- and middle-income countries, and single-dose amphotericin B reduced the nursing time required for the care of patients with cryptococcal meningitis.
Keywords: Clinical research; Cryptococcal meningitis; Liposomal amphotericin B; Research nurse.
In Uganda where the burden of HIV-associated cryptococcal meningitis is high, conventional amphotericin B deoxycholate has been standard to manage patients with cryptococcal meningitis in research settings. However, liposomal amphotericin B is now available via the efforts of UNITAID. Liposomal amphotericin B is known to be less nephrotoxic than amphotericin B deoxycholate. We demonstrated that liposomal amphotericin B is a better alternative to amphotericin B deoxycholate with less toxicity, nosocomial infections, reduced hospital stay, and the potential for lower costs of hospitalisation for both the patient and the healthcare system given the single, 10 mg/kg regimen. Despite the perceived high cost of liposomal amphotericin B and the tedious reconstitution process requiring training and adequate manpower, we believe that single-dose liposomal amphotericin B has enough advantages over the deoxycholate formulation to compel Ministries of Health to consider procuring liposomal amphotericin B as the drug of choice for the management of HIV-associated cryptococcal meningitis. The rollout will require training to facilitate widespread implementation, and we hope that this paper will serve to facilitate this training for nurses who will be using liposomal amphotericin B.
Copyright: © 2024 Ndyetukira JF et al.