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Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal.
Trans R Soc Trop Med Hyg. 2010 Mar; 104(3):225-9.TR

Abstract

Drug-related factors and parasite resistance have been implicated in the failure of pentavalent antimonials (Sb(v)) in the Indian subcontinent; however, little information is available on host-related factors. Parasitologically confirmed kala-azar patients, treatment naïve to Sb(v), were prospectively recruited at a referral hospital in Nepal and were treated under supervision with 30 doses of quality-assured sodium stibogluconate (SSG) 20mg/kg/day and followed for 12 months to assess cure. Analysis of risk factors for treatment failure was assessed in those receiving >or=25 doses and completing 12 months of follow-up. One hundred and ninety-eight cases were treated with SSG and the overall cure rate was 77.3% (153/198). Of the 181 cases who received >or=25 doses, 12-month follow-up data were obtained in 169, comprising 153 patients (90.5%) with definite cure and 16 (9.5%) treatment failures. In the final logistic regression model, increased failure to SSG was significantly associated with fever for >or=12 weeks [odds ratio (OR)=7.4], living in districts bordering the high SSG resistance zone in Bihar (OR=6.1), interruption of treatment (OR=4.3) and ambulatory treatment (OR=10.2). Early diagnosis and supervised treatment is of paramount importance to prevent treatment failures within the control programme.

Links

Publisher Full Text
linkinghub.elsevier.com
academic.oup.com

Authors+Show Affiliations

Rijal S
Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal. sumanrijal2@yahoo.com <sumanrijal2@yahoo.com>
Bhandari S
No affiliation info available
Koirala S
No affiliation info available
Singh R
No affiliation info available
Khanal B
No affiliation info available
Loutan L
No affiliation info available
Dujardin JC
No affiliation info available
Boelaert M
No affiliation info available
Chappuis F
No affiliation info available

MeSH

AdolescentAdultAntimony Sodium GluconateAntiprotozoal AgentsChildEpidemiologic MethodsFemaleHumansLeishmaniasis, VisceralMaleNepalTreatment FailureYoung Adult

Pub Type(s)

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

Language

eng

PubMed ID

19726065

Citation

Rijal, S, et al. "Clinical Risk Factors for Therapeutic Failure in Kala-azar Patients Treated With Pentavalent Antimonials in Nepal." Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 104, no. 3, 2010, pp. 225-9.
Rijal S, Bhandari S, Koirala S, et al. Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal. Trans R Soc Trop Med Hyg. 2010;104(3):225-9.
Rijal, S., Bhandari, S., Koirala, S., Singh, R., Khanal, B., Loutan, L., Dujardin, J. C., Boelaert, M., & Chappuis, F. (2010). Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal. Transactions of the Royal Society of Tropical Medicine and Hygiene, 104(3), 225-9. https://doi.org/10.1016/j.trstmh.2009.08.002
Rijal S, et al. Clinical Risk Factors for Therapeutic Failure in Kala-azar Patients Treated With Pentavalent Antimonials in Nepal. Trans R Soc Trop Med Hyg. 2010;104(3):225-9. PubMed PMID: 19726065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal. AU - Rijal,S, AU - Bhandari,S, AU - Koirala,S, AU - Singh,R, AU - Khanal,B, AU - Loutan,L, AU - Dujardin,J C, AU - Boelaert,M, AU - Chappuis,F, Y1 - 2009/09/01/ PY - 2009/03/03/received PY - 2009/08/04/revised PY - 2009/08/04/accepted PY - 2009/9/4/entrez PY - 2009/9/4/pubmed PY - 2010/5/28/medline SP - 225 EP - 9 JF - Transactions of the Royal Society of Tropical Medicine and Hygiene JO - Trans R Soc Trop Med Hyg VL - 104 IS - 3 N2 - Drug-related factors and parasite resistance have been implicated in the failure of pentavalent antimonials (Sb(v)) in the Indian subcontinent; however, little information is available on host-related factors. Parasitologically confirmed kala-azar patients, treatment naïve to Sb(v), were prospectively recruited at a referral hospital in Nepal and were treated under supervision with 30 doses of quality-assured sodium stibogluconate (SSG) 20mg/kg/day and followed for 12 months to assess cure. Analysis of risk factors for treatment failure was assessed in those receiving >or=25 doses and completing 12 months of follow-up. One hundred and ninety-eight cases were treated with SSG and the overall cure rate was 77.3% (153/198). Of the 181 cases who received >or=25 doses, 12-month follow-up data were obtained in 169, comprising 153 patients (90.5%) with definite cure and 16 (9.5%) treatment failures. In the final logistic regression model, increased failure to SSG was significantly associated with fever for >or=12 weeks [odds ratio (OR)=7.4], living in districts bordering the high SSG resistance zone in Bihar (OR=6.1), interruption of treatment (OR=4.3) and ambulatory treatment (OR=10.2). Early diagnosis and supervised treatment is of paramount importance to prevent treatment failures within the control programme. SN - 1878-3503 UR - https://www.unboundmedicine.com/medline/citation/19726065/Clinical_risk_factors_for_therapeutic_failure_in_kala_azar_patients_treated_with_pentavalent_antimonials_in_Nepal_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0035-9203(09)00289-2 DB - PRIME DP - Unbound Medicine ER -