Experience of research nurses with oral encochleated amphotericin B for treatment of cryptococcal meningitis in a resource-limited setting.

BACKGROUND

Besides the commonly used intravenous formulations of amphotericin B, an oral nanocrystal amphotericin B (MAT2203) formulation is being evaluated for efficacy to treat invasive fungal infections. This new experimental oral formulation has not been used before.

METHODS

Herein, we describe our experiences with using oral amphotericin B for management of patients with HIV-associated cryptococcal meningitis in Uganda from a research nurse perspective.

RESULTS

We found oral amphotericin B a better alternative to intravenous amphotericin B deoxycholate due to less toxicity, mostly limited to gastrointestinal-related toxicities only. We clinically observed no drug reactions like rigors, phlebitis, and less vomiting among patients on oral amphotericin B as compared to those on intravenous amphotericin B deoxycholate. Subjectively, meningitis symptoms of patients on oral amphotericin B seemed to overall clinically improve more rapidly compared to those receiving intravenous amphotericin B deoxycholate. Few adverse events were observed. A novel challenge with oral amphotericin was difficulty in monitoring adherence for the night doses in the absence of the healthcare providers.

CONCLUSIONS

Oral amphotericin B was generally safe and well tolerated. However, it requires some training for the nurse, patient and care takers for better administration, adherence and treatment outcomes.

TRIAL REGISTRATION: This was observational sub-study that was nested under the EnACT trial. The EnACT trial was registered prospectively. ClincalTrials.gov: NCT04031833; Registration date: July 24, 2019; Last verified: March 31, 2023.