Treatment of post-kala-azar dermal leishmaniasis with sodium stibogluconate.

Thakur, C.P.; Kumar, KM Prasanna; Sinha, Prabhat Kumar; Mishra, B N; Pandey, Avinash Kumar

doi:10.1136/bmj.295.6603.886-a

Cited by 23 publications

(14 citation statements)

References 5 publications

(1 reference statement)

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“…3 g ABD in total In contrast to ABD , a response to SAG only became noticeable at the end of the ® rst course of treatment, only seven patients could be cured with SAG and they took much longer to cure (between six and 10, 20-day courses) than those given ABD. The present results indicate that the ef® cacy of SAG in the treatment of PKDL (as in the treatment of kala-azar) is declining with time, since Thakur et al (1987) and Thakur and Kumar (1990) were able to cure all patients given a similar regim en of the drug in the 1980s. ABD is obviously now a superior treatment and not only in India.…”

Section: Discussionmentioning

confidence: 73%

“…Post-kala-azar derm al leishm aniasis (PKD L) may occur after apparent cure of kala-azar (visceral leishm aniasis), with a lag which is usually of 1± 2 years in India (Sen Gupta, 1960;Thakur et al, 1987;Thakur and Kumar, 1990) and Kenya (Muigai et al, 1991) but of much shorter duration in Sudan (Kirk, 1940;El-Hassan et al, 1992;Zijlstra et al, 1995). PKDL is characterised by hypopigmented macules (dots or con¯uent patches), reddish face, pinkish papules and nodules.…”

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confidence: 99%

“…Longer courses of the same drug initially proved much more effective (Thakur et al, 1987;Thakur and Kumar, 1990) but the ef® cacy of the drug, against kala-azar and PKDL, then seem s to have declined, with some cases responding very slowly or not at all. At the same time, amphotericin was found to more effective than SAG in the treatment of kala-azar (Mishra et al, 1991;Thakur, 1993;Thakur et al, 1993;Jha et al, 1995).…”

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confidence: 99%

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Amphotericin B is superior to sodium antimony gluconate in the treatment of Indian post kala azar dermal leishmaniasis

Thakur

Narain

Kumar

et al. 1997

Annals of Tropical Medicine And Parasitology

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Parasitologically confirmed cases of post-kala-azar dermal leishmaniasis (PKDL) were treated by infusion with amphotericin B deoxycholate (ABD; 1 mg/kg.day on days 1-20, 21-40 and 61-80) or by intramuscular injection with sodium antimony gluconate (SAG; 20-day courses at 20 mg/kg day, with 20-day, drug-free intervals). Of the 11 patients given ABD, all were cured with the three courses, none relapsed in 12 months of follow-up, all developed mild adverse effects (shivering and fever) because of the infusion, five lost their appetites, and three showed increases in their serum creatinine concentrations (although none exceeded 'normal' limits). In contrast, only seven (63%) of the 11 patients given SAG were considered treatment successes (improvement in lesions by the end of the third course) and these took six courses (two cases), nine courses (four cases) or 10 courses (one case) to cure completely. Two of the patients given SAG developed arthralgia and two others developed non-specific ST changes in their electrocardiograms (ECG), although their ECG were normal between courses. The better cure rate with ABD was not statistically significant, probably because of the small sample size. However, ABD appears to be a superior to SAG in terms of the speed of response and cure, although it is more expensive and has some nephrotoxicity. As the effectiveness of SAG against PKDL is apparently declining over time and the cost of ABD is prohibitive in poor countries such as India, a safe, cheap and more effective drug for the treatment of PKDL is needed.

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confidence: 73%

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confidence: 99%

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Amphotericin B is superior to sodium antimony gluconate in the treatment of Indian post kala azar dermal leishmaniasis

Thakur

Narain

Kumar

et al. 1997

Annals of Tropical Medicine And Parasitology

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“…[5] Studies in Indian PKDL are few and large series [6,7] in which SSG was administered intramuscularly daily described no serious changes in ECG and the patients were able to complete therapy even when the duration was extended to 200 days to combat refractoriness and prevent relapse. Arthralgia, pain and swelling at the site of injection had to be managed with analgesics, hospitalization, and brief discontinuations in the therapy.…”

Section: Discussion Discussionmentioning

confidence: 98%

A retrospective study of intravenous sodium stibogluconate alone and in combinations with allopurinol, rifampicin, and an immunomodulator in the treatment of Indian post-kala-azar dermal leishmaniasis

Ramesh¹,

Kumar²,

Kumar³

et al. 2010

Indian J Dermatol Venereol Leprol

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“…In India, cure rates as 64-92% have been documented with sodium antimony gluconate (SAG) 20 mg/kg per day for 120 days given parenteral, intramuscularly or intravenously. 13,14 Amphotericin B given parenteral at a dose of 1 mg/kg on alternate days or daily was shown to be effective and is being considered a first line therapy, especially in endemic areas with considerable SAG resistance. 15 Pentamidine too has been used at a dose of 2 mg/kg on alternate days for seven doses with a cure rate 93%; however, Amphotericin B has been found to be superior to pentamidine.…”

Section: Discussionmentioning

confidence: 99%

Post Kala Azar Dermal Leishmaniasis (PKDL) Presenting with Ulcerated Chronic Paronychia Like Lesion

Jha¹,

Anand²,

Mallik³

et al. 2014

Kathmandu Univ. Med. J.

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A 50-year-old lady, resident of urban Bihar, presented with inflamed proximal nail fold of a single digit for one and half months. The lesion on distal finger was remarkable for ulceration. Mucocutaneous examination revealed multiple hypopigmented macules and patches, notable for absence of scaling. The presence of ulceration was not consistent with chronic paronychia, hence, she was asked for biopsy. She declined and opted for trial of antibiotic and anti-fungal treatment. At two weeks of follow up, no improvement was noted at all. At the same time, she developed multiple juicy papules in perioral area and on neck. She tested positive by rK 39 tests. Histopathology from periungual area showed LD body. She was diagnosed as Post Kala-azar dermal leishmaniasis and was treated with miltefosine 50 mg twice daily for three months, resulting in complete resolution of all lesions. DOI: http://dx.doi.org/10.3126/kumj.v10i4.11010 Kathmandu Univ Med J 2012;10(4):87-90

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Treatment of post-kala-azar dermal leishmaniasis with sodium stibogluconate.

Cited by 23 publications

References 5 publications

Amphotericin B is superior to sodium antimony gluconate in the treatment of Indian post kala azar dermal leishmaniasis

Amphotericin B is superior to sodium antimony gluconate in the treatment of Indian post kala azar dermal leishmaniasis

A retrospective study of intravenous sodium stibogluconate alone and in combinations with allopurinol, rifampicin, and an immunomodulator in the treatment of Indian post-kala-azar dermal leishmaniasis

Post Kala Azar Dermal Leishmaniasis (PKDL) Presenting with Ulcerated Chronic Paronychia Like Lesion

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