Do the diminishing efficacy and increasing toxicity of sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar, India, justify its continued use as a first-line drug? An observational study of 80 cases

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

“…The drug has been used with interferon ␥, paromomycin (also known as aminosidine), or pentamidine either concomitantly or sequentially. 4,[12][13][14][15][16][17][28][29][30][31][32][33] We found 13 studies (eight comparative, three dose-finding, and two noncomparative) done between 1980 and 2001, enrolling 1562 patients in a total of 24 antimony study arms (table 3). Adequacy of allocation was difficult to assess, except for studies versus paromomycin.…”

“…Information provided 12 Sundar et al 13 Thakur et al [14][15][16] Thakur and Narayan 17 Sundar et al 18,20 Amphotericin …”

“…[13][14][15][16][17][22][23][24] No significant benefit was achieved by combining antimony with interferon ␥. In all other cases, antimony was significantly less effective than the comparator regimen.…”

Drug Resistance in Leishmaniasis

“…In most parts of the world, over 95% of previously untreated patients with VL respond to pentavalent antimonials, the recommended first-line treatment. However, the region endemic for VL in North Bihar, India, has the unique distinction of being the only region in the world where widespread primary failure to Sb(V) has been reported (141,144,154). Even in this geographical region a variation in Sb(V) sensitivity occurs with significant drug resistance at the epicenter of the epidemic and a high level of sensitivity only 200 miles away (144).…”

Recent updates and perspectives on approaches for the development of vaccines against visceral leishmaniasis

“…Chemotherapy based on the administration of pentavalent antimonials has been used to treat VL; however, these products present problems related to their toxicity (8) (9) (10) . Other drugs, such as pentamidine, miltefosine, and amphotericin B also present issues of toxicity and/or high cost (11) (12) (13) (14) .…”