Treatment of visceral leishmaniasis with sodium stibogluconate in Sudan: management of those who do not respond

Almost all (98%) of 1593 visceral leishmaniasis (VL) patients treated with sodium stibogluconate (Pentostam®; Wellcome) in Sudan between 1989 and 1995 and followed-up responded well to treatment. However, the other 33 patients, all of whom were seronegative for HIV, showed partial or no response. Th...

Full description

Saved in:
Bibliographic Details
Published in:Annals of tropical medicine and parasitology 1998-03, Vol.92 (2), p.151-158
Main Authors: Khalil, E. A. G., El Hassan, A. M., Zijlstra, E. E., Hashim, F. A., Ibrahim, M. E., Ghalib, H. W., Ali, M. S.
Format: Article
Language:English
Subjects:
Adolescent
Adult
AIDS/HIV
Amphotericin B - therapeutic use
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimony Sodium Gluconate - therapeutic use
Antiparasitic agents
Antiprotozoal Agents - therapeutic use
Biological and medical sciences
Child
Child, Preschool
Dose-Response Relationship, Drug
Drug Resistance
Female
Humans
Leishmaniasis, Visceral - complications
Leishmaniasis, Visceral - drug therapy
Male
Medical sciences
Pharmacology. Drug treatments
Splenectomy
Sudan
Tropical medicine
Tuberculosis, Pulmonary - complications
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Almost all (98%) of 1593 visceral leishmaniasis (VL) patients treated with sodium stibogluconate (Pentostam®; Wellcome) in Sudan between 1989 and 1995 and followed-up responded well to treatment. However, the other 33 patients, all of whom were seronegative for HIV, showed partial or no response. The two main causes of unresponsiveness were primary drug resistance (39.3%) and low drug dosages given at peripheral dispensaries (30.3%). All of those who had been sub-optimal doses were cured when adequate doses of the drug were given. A third cause was concurrent disease, particularly pulmonary tuberculosis (18%). With treatment of the concurrent disease, patients responded well to Pentostam. Eight patients who failed to respond to repeated courses of Pentostam did not benefit from pentamidine or sterol inhibitors. Three of these patients responded to liposomal amphotericin B, two responded to splenectomy in association with Pentostam therapy, and three died. Pentostam, given in adequate doses, still appears to be the drug of choice for the treatment of VL in the Sudan. Liposomal amphotericin B is a suitable second-line drug.
ISSN:0003-4983
1364-8594
DOI:10.1080/00034983.1998.11813274