Comparison of Regimes of Treatment of Antimony-Resistant Kala-Azar Patients: A Randomized Study

Thakur, C.P.; Kumar, Manish; Pandey, Avinash Kumar

doi:10.4269/ajtmh.1991.45.435

Cited by 87 publications

(47 citation statements)

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“…Safety is a major concern with pentamidine, with insulin-dependent diabetes mellitus being the most feared and irreversible adverse event. 54,55,57 Such an event, although not uniformly reported, occurs in 4-12% of cases. Shock, myocarditis, and fatal outcomes may be seen, although rarely in visceral leishmaniasis treatment.…”

Section: Pentamidinementioning

confidence: 99%

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

Olliaro

Guérin

Gerstl

et al. 2005

The Lancet Infectious Diseases

204

181

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Section: Pentamidinementioning

confidence: 99%

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

Olliaro

Guérin

Gerstl

et al. 2005

The Lancet Infectious Diseases

204

181

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“…The two major choices are amphotericin B and pentamidine 3 . Each of these is problematic: although amphotericin B is affordable, it may entail a prolonged and difficult course of treatment 24 26 , and pentamidine has serious side effects 23 .…”

mentioning

confidence: 99%

Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis

Santos

Marques

Farias

et al. 2002

Rev. Soc. Bras. Med. Trop.

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Although treatment of visceral leishmaniasis with pentavalent antimony is usually successful, some patients require second-line drug therapy, most commonly with amphotericin B. To identify the clinical characteristics that predict an inadequate response to pentavalent antimony, a case-control study was undertaken in Teresina, Piaui, Brazil. Over a two-year period, there were 19 cases of VL in which the staff physicians of a hospital prescribed second-line therapy with amphotericin B after determining that treatment with pentavalent antimony had failed. The control group consisted of 97 patients that were successfully treated with pentavalent antimony. A chart review using univariate and multivariate analysis was performed. The cure rate was 90% with amphotericin B. The odds ratio for the prescription of amphotericin B was 10.2 for children less than one year old, compared with individuals aged over 10 years. Patients who presented coinfection had an OR of 7.1 while those on antibiotics had an OR of 2.8. These data support either undertaking a longer course of therapy with pentavalent antimony for children or using amphotericin B as a first-line agent for children and individuals with coinfections. It also suggests that chemoprophylaxis directed toward bacterial coinfection in small children with VL may be indicated. Key-words: Visceral leishmaniasis. Antimony. Amphotericin B. Therapy.Resumo Embora o tratamento da leishmaniose visceral com antimoniato pentavalente seja normalmente bem sucedido, alguns pacientes requerem uma terapêutica de segunda linha, habitualmente com anfotericina B. Para identificar as características clínicas que possam indicar uma resposta inadequada ao antimônio pentavalente, realizou-se um estudo caso-controle em Teresina, Piauí, Brasil. Em um período de dois anos ocorreram 19 casos de LV para quem os médicos de um hospital prescreveram o tratamento de segunda linha com anfotericina B após determinarem falha com o uso de antimônio pentavalente. O grupo controle foi constituído por 97 pacientes que tiveram o tratamento com antimônio bem sucedido. Foi feita uma análise de prontuários, utilizando-se análise univariada e multivariada. A porporção de cura após o uso de anfotericina B foi 90%. A razão de odds para a prescrição de anfotericina B foi 10,2 para crianças com menos de um ano, quando comparadas com pessoas com mais de 10 anos. Pacientes que tinham tido co-infecção tinham uma RO de 7,1 e aqueles que tinham utilizado antibióticos tinham uma razão de odds de 2,8. Estes dados estão de acordo com o uso mais prolongado de antimônio pentavalente para crianças ou com a recomendação de anfotericina B como droga de primeira escolha para crianças e para pessoas com co-infecções. Sugerem também que se pode indicar a quimioprofilaxia para infecções bacterianas em crianças menores com LV. Palavras-chaves: Leishmaniose visceral. Antimônio. Anfotericina B. Terapêutica.

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“…Drug should be stopped on QTc prolongation or ST-T changes, which might be the signs of impending fatal arrythmias [9]. Thakur et al reported cure rate of 77% in SSG unresponsive patients, with, 15 inj of pentamidine [11]. Jha et al reported 75.2% cure rate [12].…”

Section: Discussionmentioning

confidence: 99%

Problems in Management of Kala Azar: Experience From Bihar

Rai

Bandyopadhyay

2001

Medical Journal Armed Forces India

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35 cases of Kala-Azar were managed at 200 bedded peripheral hospital, Bihar from Jan 1994 to Jan 1998. Patients presenting with history of fever for more than 3 weeks duration with splenomegaly or hepatosplenomegaly were investigated for Kala-Azar. A confirmative diagnosis of Kala-Azar was made in all cases by demonstrating Leishmania amastigote (LD body) in bone marrow or splenic aspirate. All patients were initially treated by sodium stibogluconate (SSG) 20 mglkg body wt daily for 20 to 40 days depending on response. SSG induced cardiac toxicity was seen in 6 cases (VT-2, ST-T changes-2, QTc Prolongation-2) out of which 1 patient died of refractory ventricular tachyacarida. 9 patients were unresponsive to SSG,8 patients were treated with pentamidine isoethionate (4 mg/kg body wt IV alternate day) 10-15 dosage. 1 patient was treated with amphotericin-B. AU the patients showed clinical and parasitological improvement and no relapse was noted at 6 month follow up. 6 patients had associated tuberculosis (Disseminated TB-2, Miliary TB·l, Pulmonary TB-!. Pleural TB-2). 2 patients had associated pneumonia, 1 patient had HIV infection and 1 patient had erythema nodosum leperosum.

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Comparison of Regimes of Treatment of Antimony-Resistant Kala-Azar Patients: A Randomized Study

Cited by 87 publications

References 0 publications

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

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

Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis

Problems in Management of Kala Azar: Experience From Bihar

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