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

Abstract

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.