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Factors related to amphotericin-B-induced rigors (shivering)
P Carney-Gersten1, M Giuffre, D Levy
1University of Washington School of Nursing, Seattle.
Abstract:
Amphotericin-B is the only parenteral agent currently available to treat systemic fungal infections. Pyrogenesis, accompanied by severe shivering, is a distressing side effect. Possible risk factors of developing this reaction have not been reported. A case series was developed to document the occurrence and duration of shivering in patients who received amphotericin-B and to investigate whether these responses were associated with a diagnosis of diabetes mellitus, receipt of insulin or beta blockers, the amount of body fat content, an immunocompromised state, age, and gender. Medical records were reviewed and abstracted for patients who received 20 milligrams or more of amphotericin-B per day for at least 10 consecutive days between January 1, 1984, and September 1, 1988. Results indicated that a diagnosis of diabetes, insulin therapy, and advancing age were inversely associated with the amphotericin-B-induced rigors response. Shivering was noted to occur first at the test dose, with the percentage of patients who shivered increasing with each successive dose (this peaked at the fifth therapeutic dosage). Of the factors under study, only advancing age appeared to be related to the duration of shivering. It is possible that identification of the descriptive characteristics of amphotericin-B-induced rigors will facilitate the nursing care of patients who receive this treatment; it also may be an important first step in the identification of risk factors for this clinical complication.
Insights
Amphotericin-B can cause severe shivering, a distressing side effect. This study found that diabetes, insulin use, and older age were linked to fewer shivering reactions in patients receiving this antifungal medication.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Amphotericin-B is a critical parenteral antifungal agent for systemic infections.
- Pyrogenesis with severe shivering is a common and distressing side effect of Amphotericin-B.
- Risk factors for Amphotericin-B-induced rigors remain largely unreported.
Purpose of the Study:
- To document the occurrence and duration of shivering in patients treated with Amphotericin-B.
- To investigate potential risk factors associated with Amphotericin-B-induced rigors, including diabetes, insulin therapy, beta-blockers, body fat, immunocompromised status, age, and gender.
Main Methods:
- A retrospective case series design was employed.
- Medical records of patients receiving ≥20 mg Amphotericin-B daily for ≥10 consecutive days (1984-1988) were reviewed.
- Data on patient demographics and clinical factors were abstracted.
Main Results:
- Diabetes diagnosis, insulin therapy, and advancing age showed an inverse association with Amphotericin-B-induced rigors.
- Shivering typically began with the test dose and increased with successive doses, peaking at the fifth therapeutic dose.
- Advancing age was the only studied factor significantly related to the duration of shivering.
Conclusions:
- Identifying characteristics of Amphotericin-B-induced rigors can improve nursing care for patients receiving this treatment.
- Further research into risk factors may help predict and mitigate this clinical complication.