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Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline.
Trans R Soc Trop Med Hyg. 2003 May-Jun; 97(3):350-4.TR

Abstract

Sodium stibogluconate (SSG) is the first-line therapy for visceral leishmaniasis (VL) in south-eastern Nepal. Recent studies from the neighbouring state of Bihar, India, have shown a dramatic fall in cure rates with treatment failure occurring in up to 65% of VL patients treated with SSG. A prospective study was conducted at a tertiary-level hospital located in south-eastern Nepal from July 1999 to January 2001. Parasitologically proven kala-azar patients with no previous history of treatment for VL were treated with SSG 20 mg/kg/d for 30 d which was extended to 40 d in those with persistent positive parasitology. Of the 110 patients who completed SSG therapy and were assessed at 1 and 6 months, definite cure was achieved in 99 patients (90%) and SSG failure occurred in 11 patients (10%). Except for the presence of hepatomegaly and a lower platelet count there was no clinical or laboratory baseline characteristic associated with treatment failure. A significantly lower cure rate (76%, P = 0.03) was observed in patients from the district of Saptari, which borders the antimony-resistant VL areas of Bihar. The efficacy of SSG as a first-line treatment for VL in south-eastern Nepal was still satisfactory, except for the patients living closer to the antimony-resistant VL areas of India. These findings indicate that the spread of resistance to antimonials is already taking place in Nepal and that a policy to control further spread should be urgently implemented.

Authors+Show Affiliations

Rijal S
B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Chappuis F
No affiliation info available
Singh R
No affiliation info available
Bovier PA
No affiliation info available
Acharya P
No affiliation info available
Karki BM
No affiliation info available
Das ML
No affiliation info available
Desjeux P
No affiliation info available
Loutan L
No affiliation info available
Koirala S
No affiliation info available

MeSH

AdultAntimony Sodium GluconateAntiprotozoal AgentsDrug ResistanceEndemic DiseasesFemaleHumansLeishmaniasis, VisceralMaleMiddle AgedNepalProspective StudiesRisk FactorsTreatment Failure

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15228258

Citation

Rijal, S, et al. "Treatment of Visceral Leishmaniasis in South-eastern Nepal: Decreasing Efficacy of Sodium Stibogluconate and Need for a Policy to Limit Further Decline." Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 97, no. 3, 2003, pp. 350-4.
Rijal S, Chappuis F, Singh R, et al. Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline. Trans R Soc Trop Med Hyg. 2003;97(3):350-4.
Rijal, S., Chappuis, F., Singh, R., Bovier, P. A., Acharya, P., Karki, B. M., Das, M. L., Desjeux, P., Loutan, L., & Koirala, S. (2003). Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline. Transactions of the Royal Society of Tropical Medicine and Hygiene, 97(3), 350-4.
Rijal S, et al. Treatment of Visceral Leishmaniasis in South-eastern Nepal: Decreasing Efficacy of Sodium Stibogluconate and Need for a Policy to Limit Further Decline. Trans R Soc Trop Med Hyg. 2003 May-Jun;97(3):350-4. PubMed PMID: 15228258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline. AU - Rijal,S, AU - Chappuis,F, AU - Singh,R, AU - Bovier,P A, AU - Acharya,P, AU - Karki,B M S, AU - Das,M L, AU - Desjeux,P, AU - Loutan,L, AU - Koirala,S, PY - 2004/7/2/pubmed PY - 2004/10/6/medline PY - 2004/7/2/entrez SP - 350 EP - 4 JF - Transactions of the Royal Society of Tropical Medicine and Hygiene JO - Trans R Soc Trop Med Hyg VL - 97 IS - 3 N2 - Sodium stibogluconate (SSG) is the first-line therapy for visceral leishmaniasis (VL) in south-eastern Nepal. Recent studies from the neighbouring state of Bihar, India, have shown a dramatic fall in cure rates with treatment failure occurring in up to 65% of VL patients treated with SSG. A prospective study was conducted at a tertiary-level hospital located in south-eastern Nepal from July 1999 to January 2001. Parasitologically proven kala-azar patients with no previous history of treatment for VL were treated with SSG 20 mg/kg/d for 30 d which was extended to 40 d in those with persistent positive parasitology. Of the 110 patients who completed SSG therapy and were assessed at 1 and 6 months, definite cure was achieved in 99 patients (90%) and SSG failure occurred in 11 patients (10%). Except for the presence of hepatomegaly and a lower platelet count there was no clinical or laboratory baseline characteristic associated with treatment failure. A significantly lower cure rate (76%, P = 0.03) was observed in patients from the district of Saptari, which borders the antimony-resistant VL areas of Bihar. The efficacy of SSG as a first-line treatment for VL in south-eastern Nepal was still satisfactory, except for the patients living closer to the antimony-resistant VL areas of India. These findings indicate that the spread of resistance to antimonials is already taking place in Nepal and that a policy to control further spread should be urgently implemented. SN - 0035-9203 UR - https://www.unboundmedicine.com/medline/citation/15228258/Treatment_of_visceral_leishmaniasis_in_south_eastern_Nepal:_decreasing_efficacy_of_sodium_stibogluconate_and_need_for_a_policy_to_limit_further_decline_ DB - PRIME DP - Unbound Medicine ER -