Clinicians knowledge, prescribing patierns, toxicity and efficacy of amphotericin B in HIV positive patients at Kenyatta national hospital

Abstract

Introduction-Amphotericin B is a drug used to treat cryptococcal meningitis in AIDS patients. It is associated with many adverse drug reactions such as nephrotoxicity, cardiotoxicity and anemia. The prevalence of these adverse drug reactions has not been investigated in Kenya. Secondly clinicians may lack knowledge on administration of Amphotericin B. thus increasing the risk of adverse drug reactions. HIVIAIDS are particularly prone to adverse drug reactions. Purpose The purpose of the study is to determine the incidence of Amphotericin B induced ADRS amongst patients in a National hospital in Nairobi. The risk factors for experiencing adverse drug reactions will be identified. In addition, the knowledge of clinicians with regard to the administration of the drug and its side effects will be determined. The study will also determine if appropriate biochemical and hematological parameters are monitored during therapy. Study setting -Kenyatta National Hospital methodology: This was a retrospective descriptive cohort study. The study population 1include adults with or without HIV IAIDS treated between the years 200S-20l0.The patients aged between 18-54 years were included and a total of 144 files were randomly sampled. In addition questionnaires were administered to above twenty clinicians and other health workers based in Kenyatta national hospital. Data was analyzed by descriptive inferential methods using SPSS soft ware. Confounding was adjusted for by logistic regression. The findings of the study were to be used to bridge the gap in the clinician's knowledge in the administration of Amphotericin B. and to improving the treatment protocol for use of Amphotericin B conclusion: Baseline characteristics of patients on Amphotericin B between the years 2005-2010 at Kenyatta hospital The median age of patients treated with Amphotericin B at Kenyatta National Hospital was 37 years and the range was (18-59). Those who were above 40 years (60.2%) were more than those who were below 40 years of age (39.8 %).There is relatively equal proportions of male (47.2 %) and female (46.6 %) clinical characteristics of patients at admission. All patients had a fungal infection. The most common fungal infection was cryptococcal meningitis with a prevalence of (100 %). Diagnosis was confirmed using the Indian ink test. All patients were HIV positive with a median CD4 count of 41 cells/mI3 . Viral loads were not determined. The parameters, hemoglobin, BUN and creatinine levels were recorded as these are potential risk factors for Amphotericin B induced adverse effects. However this data was not available for most patients. Co-morbility: At the time of admission 100% of patients had HIV and AIDS, Cryptococcal meningitis infection occurs mostly in AIDS patients as an opportunistic infection and the recommended treatment is Amphotericin B. The second most common co-morbidity was tuberculosis, with a prevalence of20.5 %. The third most common co-morbidity is sepsis; with a prevalence of 5%.