Clinicoepidemiological study of drug resistance in Indian kala - azar

Treatment options for visceral leishmaniasis: a systematic review of clinical studies done in India, 1980–2004

“…As little as one in four patients who failed on antimony had adequate treatment, and more than 40% interrupted treatment before completion. 73 In time, this failure has led to an increase in doses and time of hospitalisation, and the need to retreat failures with rescue drugs; morbidity and the burden of disease have increased, and so have costs to the patients and the health sector. Now we need an antimony replacement.…”

Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal

“…6 In contrast, Sb v therapy continues to be effective in HIV-negative kala-azar patients in Bangladesh and East Africa. [7][8][9] Several factors have been implicated in the therapeutic failure of Sb v , either drug-related, such as inadequate or incomplete regimens 10 or the use of substandard preparations, 11 or parasite-or host-related. Antimonialresistant parasites have been described among clinical isolates from India and Nepal.…”

Drug Resistance in Leishmaniasis

“…It has been observed that only a minority of patients (26%) were treated according to prescribed guidelines: irregular use and incomplete treatments were a common occurrence. These facts point to the mishandling of antileishmanial drugs in Bihar as a significant contributor to the development of drug resistance (147).…”

“…A similar potential for resistance to develop exists in East Africa, especially in Sudan, another anthroponotic focus of VL with intense transmission, where poverty, illiteracy, and poor health care facilities portend misuse of the drug and consequent emergence of resistance. Resistance seems to be a feature of intensive transmission of anthroponotic L. donovani as epidemic turns to endemic in foci where Sb(V) has been used as monotherapy for long periods, often with poor supervision and compliance (146,147). In other parts of the world, Sb(V) continues to be effective (34,156).…”

“…Sb(V) is freely available in India, and is easily accessible over the counter. Most patients (73%) first consult unqualified medical practitioners, who might not use the drug appropriately (147). It has been a common practice to start with a small dose and gradually increase the dose over a week.…”