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The safety of i.v. pentamidine administered in an ambulatory setting
1Department of Medicine, Toronto Hospital and Wellesley Hospital, University of Toronto, Ontario, Canada.
Abstract:
I.v. pentamidine is well known to cause severe multiorgan adverse effects and is usually given to hospitalized patients under close monitoring. The primary purpose of this retrospective quality assurance study is to assess the safety of administering i.v. pentamidine in the medical daycare unit (MDCU) for outpatients. Thirty-five outpatients infected with the HIV made 306 visits to the MDCU from January 1991 to December 1993. They received i.v. pentamidine in a dosage of either 300 mg once a month for prophylaxis or 4 mg/kg/d 5 days a week for treatment of Pneumocystis carinii pneumonia (PCP). BP was monitored every 15 to 30 min over 3 to 4 h and clinical side effects were noted. CBC count, BUN, creatinine, amylase, and blood glucose values were taken twice a week. The records were reviewed retrospectively and analyzed for clinical and biochemical derangement. GI side effects occurred in 59 of 306 (19%) visits; 43 (73%) of the side effects were nausea. Routine normal saline solution boluses before and after pentamidine infusion prevented the drop in BP and actually significantly elevated BP after i.v. pentamidine. The most common biochemical derangement was elevated BUN level in eight patients and creatinine in nine patients, but they were mild and required no intervention. Significant neutropenia occurred in three, anemia in two, hyponatremia in two, hyperamylasemia in two, and hyperglycemia in two patients. No palpitation or irregular pulse was encountered. No death was associated with the administration of i.v. pentamidine. Three patients required hospital admission. Only one hospital admission was definitely related to adverse drug effects. In conclusion, the side effects of i.v. pentamidine are common but minor. We conclude that it is safe to administer i.v. pentamidine in carefully selected patients with appropriate monitoring in an ambulatory setting. This has a major health economic implication, because ambulatory i.v. pentamidine can result in significant cost savings and can also enhance quality of life. Further studies regarding the feasibility of home administration of i.v. pentamidine is warranted as even further cost savings and improvement in the quality of life of HIV-infected patients may be achieved.
Insights
Administering intravenous pentamidine to outpatients in a medical daycare unit is safe and effective. This approach minimizes adverse effects and offers significant cost savings for HIV patients.
Area of Science:
- Infectious Diseases
- Pharmacology
- Quality Assurance
Background:
- Intravenous pentamidine is typically administered to hospitalized patients due to severe adverse effects.
- Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in HIV-infected individuals.
Purpose of the Study:
- To assess the safety and efficacy of administering intravenous pentamidine in a medical daycare unit (MDCU) for outpatients.
- To evaluate clinical and biochemical adverse effects of outpatient i.v. pentamidine administration.
Main Methods:
- Retrospective quality assurance study of 35 HIV-infected outpatients receiving i.v. pentamidine in an MDCU.
- Monitoring of blood pressure, clinical side effects, complete blood count (CBC), BUN, creatinine, amylase, and blood glucose.
- Analysis of records for clinical and biochemical derangements over 306 visits.
Main Results:
- Gastrointestinal side effects (nausea) occurred in 19% of visits; most were minor.
- Routine saline boluses effectively prevented or elevated blood pressure during infusion.
- Mild biochemical derangements (elevated BUN, creatinine) were noted but required no intervention.
- Adverse events like neutropenia, anemia, hyponatremia, hyperamylasemia, and hyperglycemia were infrequent.
- No deaths occurred; only one hospital admission was definitively linked to adverse drug effects.
Conclusions:
- Outpatient i.v. pentamidine administration in a monitored MDCU setting is safe for carefully selected patients.
- The side effect profile of i.v. pentamidine in this setting is predominantly minor.
- Ambulatory administration offers significant health economic benefits, including cost savings and improved quality of life for HIV patients.
- Further research into home administration of i.v. pentamidine is warranted to maximize cost savings and patient quality of life.