Treatment of visceral leishmaniasis in children with liposomal amphotericin B

Martino, L. Di; Davidson, Robert N.; Giacchino, Raffella; Scotti, Silvestro; Raimondi, Francesco; Castagnola, Elio; Tasso, Loredana; Cascio, Antonio; Gradoni, Luigi; Gramiccia, Marina; Pettoello-Mantovani, Massimo; Bryceson, A. D. M.

doi:10.1016/s0022-3476(97)70165-3

Cited by 63 publications

(35 citation statements)

References 35 publications

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“…Patients were treated with meglumine antimoniate (Glucantim; Aventis Pharma, Italy) or with liposomal amphotericin B (LAmB) (AmBisome; Gilead, USA). Six of these patients had been enrolled in clinical trials [6,7,8]. Meglumine antimoniate was administered intramuscularly, generally for 21 days at a dosage of 560 mg/m 2 of Sb V after a gradually increasing daily dose during the first 3-4 days of therapy.…”

Section: Methodsmentioning

confidence: 99%

Pediatric Visceral Leishmaniasis in Western Sicily, Italy: A Retrospective Analysis of 111 Cases

Cascio

Colomba

Antinori

et al. 2002

Eur J Clin Microbiol Infect Dis

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The clinical and epidemiological characteristics of 111 consecutive cases of visceral leishmaniasis identified from 1980 to 2000 in a Sicilian pediatric hospital were analyzed retrospectively. The mean age of the patients was 1.7 years. All children were HIV negative, but 15% were severely malnourished. Fever and splenomegaly were present in all cases and hepatomegaly in 101 (90.1%) cases. Thrombocytopenia and anemia were both observed in 78 (70.2%) cases and leukopenia in 47 (42.3%) cases. A bone marrow aspirate was obtained in all cases; Leishmania amastigotes were detected in 89 (80.2%) cases. Initial treatment consisted of meglumine antimoniate in 99 (89.2%) patients and amphotericin B in 12 (10.8%) patients. Only two children treated with meglumine antimoniate relapsed. The findings highlight the differences between the cases of visceral leishmaniasis observed in the Mediterranean basin and those observed in other regions. The use of the term "Mediterranean visceral leishmaniasis", rather than the term "kalaazar", is proposed for cases observed in the Mediterranean area.

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Section: Methodsmentioning

confidence: 99%

Pediatric Visceral Leishmaniasis in Western Sicily, Italy: A Retrospective Analysis of 111 Cases

Cascio

Colomba

Antinori

et al. 2002

Eur J Clin Microbiol Infect Dis

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“…Provided sufficient total doses are administered, short-course regimens of as brief as 5 days (using daily infusions) or up to 10 days (during which five or six infusions are given) are remarkably active (49,53,169,176). Efficacy has been documented worldwide in children and adults and in severely ill patients under appalling conditions in war-torn Sudan (23,54,154).…”

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confidence: 99%

“…Brazilian infection (L. chagasi), mostly in children, responds to amphotericin B cholesterol dispersion (Amphotec; Sequus Pharmaceuticals, Inc., Menlo Park, Calif.) but may be less responsive to AmBisome (23,53,64). In the Mediterranean region, where young children are often targets for L. infantum, higher total doses of AmBisome are required but the response rate is near 100% (54).…”

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confidence: 99%

Clinical and Experimental Advances in Treatment of Visceral Leishmaniasis

Murray

2001

Antimicrob Agents Chemother

201

184

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“…In the Mediterranean region, where VL is caused by L. infantum, higher total doses of a lipid formulation of amphotericin B are required to induce reasonable cure response, compared with those required for treatment of VL caused by L. donovani. Published reports of efficacious short-course regimens that use a lipid formulation of amphotericin B suggest that total doses of 18-24 mg/kg, given in у5 doses during a 10-day period, would be optimal for the treatment of VL due to L. infantum [11,12].…”

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confidence: 99%

Two Doses of a Lipid Formulation of Amphotericin B for the Treatment of Mediterranean Visceral Leishmaniasis

et al. 2003

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To evaluate the efficacy of a short course of a lipid formulation of amphotericin B (L-AmB) for the treatment of Mediterranean visceral leishmaniasis (VL), an open prospective study was conducted. Forty-one children with parasitologically confirmed leishmaniasis received L-AmB, 10 mg/kg daily for 2 days. The comparison groups were 30 children who, in a previous study, were treated with L-AmB, 4 mg/kg daily for 5 days, and 52 children who were treated with meglumine antimoniate. At 6 months after completion of treatment, overall treatment success was noted for 40 of 41 children treated with 2 doses of L-AmB, 27 of 30 children treated with 5 doses of L-AmB, and 47 of 52 children treated with meglumine antimoniate. Abatement of fever, reduction in spleen size, and correction of laboratory parameters occurred more quickly among the children who received 2 doses of L-AmB than among the comparison groups, and the total estimated cost of the 2-dose regimen was also lower than that of the other regimens. Two doses of L-AmB, 10 mg/kg each, is costeffective therapy for Mediterranean VL in children.Visceral leishmaniasis (VL) is endemic in the Mediterranean countries and affects ∼1000 people annually [1]. In Athens, Greece, where the present study was conducted, the estimated annual incidence of the disease is 1.2 cases per 100,000 residents, and the relative annual incidence for children р14 years of age is 3.2 cases per 100,000 children [2]. The disease is caused by 3 taxa of the genus Leishmania, each of which is associated with a specific geographic distribution: Leishmania donovani is most often found in Asia and Africa; Leishmania infantum, in the Mediterranean basin; and Leishmania chagasi, in South America [3,4]. After in- oculation of the skin by sandfly vectors, Leishmania parasites replicate within macrophages in the liver, spleen, bone marrow, and, sometimes, the lymph nodes, resulting in visceral disease that is usually fatal if it is not treated.Although pentavalent antimony has been the mainstay of therapy for VL for more than half a century, its use is hindered by drug toxicity or intolerance, by drug resistance in certain geographic areas [5,6], and by prolonged inconvenient administration. Lately, lipid formulations of amphotericin B have been used successfully for the treatment of VL worldwide, although there are regional differences in the effectiveness of such formulations [7][8][9][10]. In the Mediterranean region, where VL is caused by L. infantum, higher total doses of a lipid formulation of amphotericin B are required to induce reasonable cure response, compared with those required for treatment of VL caused by L. donovani. Published reports of efficacious short-course regimens that use a lipid formulation of amphotericin B

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Treatment of visceral leishmaniasis in children with liposomal amphotericin B

Cited by 63 publications

References 35 publications

Pediatric Visceral Leishmaniasis in Western Sicily, Italy: A Retrospective Analysis of 111 Cases

Pediatric Visceral Leishmaniasis in Western Sicily, Italy: A Retrospective Analysis of 111 Cases

Clinical and Experimental Advances in Treatment of Visceral Leishmaniasis

Two Doses of a Lipid Formulation of Amphotericin B for the Treatment of Mediterranean Visceral Leishmaniasis

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