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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.
Indian J Dermatol Venereol Leprol. 2010 Mar-Apr; 76(2):138-44.IJ

Abstract

BACKGROUND AND AIMS

A retrospective analysis of treatment outcome using recommended dose of sodium stibogluconate (SSG) alone and in combination with other antileishmanial drugs in adults with post-kala-azar dermal leishmaniasis (PKDL) attending as outpatients.

METHODS

A total of 61 patients seen over ten years were included in the report. All had polymorphic lesions. Diagnosis was based on clinical picture, hailing from kala-azar (KA) endemic area, exclusion of other dermatoses, histopathology, and therapeutic response. Patients were distributed into two groups: Group I (n = 32), where SSG was given intravenously; in Group II (n = 29), they were allocated to one of four categories using SSG in combination with other drugs. In the first category, SSG was given along with allopurinol (n = 10); in second with rifampicin (n = 6); and in third with both allopurinol and rifampicin (n = 5). In the fourth category, SSG was administered with an immunomodulator (n = 8), Mw vaccine, known to enhance host Th1 response.

RESULTS

Only 12 out of 61 patients completed treatment till histopathologic evidence of cure, five in Group I and seven in Group II, no patient being from third category. None had taken SSG without interruptions. Time taken for papulonodules to subside was similar in both groups, but erythema and induration subsided earlier in Group II. Group I patients attained cure after 120 injections while in Group II it took 95 injections in SSG + allopurinol and Mw vaccine categories respectively, and 110 with SSG + rifampicin. Nevertheless this was insufficient to facilitate compliance. Poor performance and high dropouts related to long duration of therapy, thrombophlebitis, difficulty in accessing veins, disabling rheumatic side-effects and practical problems. Liver, renal and pancreatic functions and ECG remained normal.

CONCLUSION

No major advantage was obtained using allopurinol, rifampicin or Mw vaccine along with SSG as compared to SSG alone.

Links

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Authors+Show Affiliations

Ramesh V
Department of Dermatology and Regional STD Center and Institute of Pathology (ICMR), Safdarjang Hospital and VM Medical College, New Delhi-110 029, India.
Kumar J
No affiliation info available
Kumar D
No affiliation info available
Salotra P
No affiliation info available

MeSH

AdolescentAdultAgedAllopurinolAntimony Sodium GluconateDrug Therapy, CombinationFemaleFollow-Up StudiesHumansImmunologic FactorsIndiaInfusions, IntravenousLeishmaniasis, CutaneousLeishmaniasis, VisceralMaleMiddle AgedRetrospective StudiesRifampinTreatment OutcomeYoung Adult

Pub Type(s)

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

Language

eng

PubMed ID

20228542

Citation

Ramesh, V, et al. "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." Indian Journal of Dermatology, Venereology and Leprology, vol. 76, no. 2, 2010, pp. 138-44.
Ramesh V, Kumar J, Kumar D, et al. 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. Indian J Dermatol Venereol Leprol. 2010;76(2):138-44.
Ramesh, V., Kumar, J., Kumar, D., & Salotra, P. (2010). 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. Indian Journal of Dermatology, Venereology and Leprology, 76(2), 138-44. https://doi.org/10.4103/0378-6323.60553
Ramesh V, et al. 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. Indian J Dermatol Venereol Leprol. 2010 Mar-Apr;76(2):138-44. PubMed PMID: 20228542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Ramesh,V, AU - Kumar,Joginder, AU - Kumar,Dhiraj, AU - Salotra,Poonam, PY - 2010/3/16/entrez PY - 2010/3/17/pubmed PY - 2010/9/24/medline SP - 138 EP - 44 JF - Indian journal of dermatology, venereology and leprology JO - Indian J Dermatol Venereol Leprol VL - 76 IS - 2 N2 - BACKGROUND AND AIMS: A retrospective analysis of treatment outcome using recommended dose of sodium stibogluconate (SSG) alone and in combination with other antileishmanial drugs in adults with post-kala-azar dermal leishmaniasis (PKDL) attending as outpatients. METHODS: A total of 61 patients seen over ten years were included in the report. All had polymorphic lesions. Diagnosis was based on clinical picture, hailing from kala-azar (KA) endemic area, exclusion of other dermatoses, histopathology, and therapeutic response. Patients were distributed into two groups: Group I (n = 32), where SSG was given intravenously; in Group II (n = 29), they were allocated to one of four categories using SSG in combination with other drugs. In the first category, SSG was given along with allopurinol (n = 10); in second with rifampicin (n = 6); and in third with both allopurinol and rifampicin (n = 5). In the fourth category, SSG was administered with an immunomodulator (n = 8), Mw vaccine, known to enhance host Th1 response. RESULTS: Only 12 out of 61 patients completed treatment till histopathologic evidence of cure, five in Group I and seven in Group II, no patient being from third category. None had taken SSG without interruptions. Time taken for papulonodules to subside was similar in both groups, but erythema and induration subsided earlier in Group II. Group I patients attained cure after 120 injections while in Group II it took 95 injections in SSG + allopurinol and Mw vaccine categories respectively, and 110 with SSG + rifampicin. Nevertheless this was insufficient to facilitate compliance. Poor performance and high dropouts related to long duration of therapy, thrombophlebitis, difficulty in accessing veins, disabling rheumatic side-effects and practical problems. Liver, renal and pancreatic functions and ECG remained normal. CONCLUSION: No major advantage was obtained using allopurinol, rifampicin or Mw vaccine along with SSG as compared to SSG alone. SN - 0973-3922 UR - https://www.unboundmedicine.com/medline/citation/20228542/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_ L2 - http://www.ijdvl.com/article.asp?issn=0378-6323;year=2010;volume=76;issue=2;spage=138;epage=144;aulast=Ramesh DB - PRIME DP - Unbound Medicine ER -