THE SAFETY OF IV PENTAMIDINE ADMINISTERED IN AN AMBULATORY SETTING

IV pentamidine is well known to cause severe multiorgan adverse effect s 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 IV pentamidine in the medical d aycare unit (MDCU) for outpatients, Thirty-five outpatients infected w ith the HIV made 306 visits to the MDCU from January 1991 to December 1993, They received IV 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 Pne umocystis 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, c reatinine, amylase, and blood glucose values were taken twice a week, The records were reviewed retrospectively and analyzed for clinical an d biochemical derangement. GI side effects occurred in 59 of 306 (19%) visits; 43 (73%) of the side effects were nausea, Routine normal sali ne solution boluses before and after pentamidine infusion prevented th e drop in BP and actually significantly elevated BP after IV pentamidi ne, 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 hyperg lycemia in two patients, No palpitation or irregular pulse was encount ered, No death was associated with the administration of IV pentamidin e. Three patients required hospital admission, Only one hospital admis sion was definitely related to adverse drug effects, In conclusion, th e side effects of IV pentamidine are common but minor. We conclude tha t it is safe to administer nr pentamidine in carefully selected patien ts with appropriate monitoring in an ambulatory setting. This has a ma jor health economic implication, because ambulatory IV pentamidine can result in significant cost savings and can also enhance quality of li fe, Further studies regarding the feasibility of home administration o f IV pentamidine is warranted as even further cost savings and improve ment in the quality of life of HIV-infected patients may be achieved.