Unresponsiveness to AmBisome in some Sudanese patients with kala-azar.
AffiliationMedécins Sans Frontières, Plantage Middenlaan 14, 1018 DD Amsterdam, The Netherlands.
MetadataShow full item record
AbstractIn Sudan, two treatments are currently registered for visceral leishmaniasis: sodium stibogluconate (SSG) as first line and liposomal amphotericin B (AmBisome) as second line. We present 64 patients (52 relapse cases to SSG, 12 new but complicated cases) treated with AmBisome in eastern Sudan. AmBisome was administered at 2.5-8.2mg/kg (15-49mg/kg in total) per dose six times (days 1, 2, 3, 5, 10, 15) as an intravenous infusion. We measured outcome according to clinical response and parasitological clearance (lymph node aspiration). Patient outcomes fell into three groups: group 1, clinical responders (cured) with a negative test of cure (n=35); group 2, clinical responders with a positive test of cure (n=19); group 3, clinical non-responders (failures) with a positive test of cure (n=10). Of the 10 failures, six were already relapse cases. All of group 3, and 15 from group 2, were also treated with additional SSG (20mg/kg intramuscularly daily for 30-50 d) with resulting clinical and parasitological improvement. Parasite persistence and clinical failure were associated with a higher parasite density on admission (P<0.002) and underlying immunosuppressive disease: tuberculosis (three cases) or HIV (two cases). Because AmBisome monotherapy may fail in Sudan, a combination of AmBisome and SSG is recommended for relapse cases.
- Limited effectiveness of high-dose liposomal amphotericin B (AmBisome) for treatment of visceral leishmaniasis in an Ethiopian population with high HIV prevalence.
- Authors: Ritmeijer K, ter Horst R, Chane S, Aderie EM, Piening T, Collin SM, Davidson RN
- Issue date: 2011 Dec
- Efficacy and safety of liposomal amphotericin B (AmBisome) for visceral leishmaniasis in endemic developing countries.
- Authors: Berman JD, Badaro R, Thakur CP, Wasunna KM, Behbehani K, Davidson R, Kuzoe F, Pang L, Weerasuriya K, Bryceson AD
- Issue date: 1998
- Liposomal amphotericin B for complicated visceral leishmaniasis (kala-azar) in eastern Sudan: how effective is treatment for this neglected disease?
- Authors: Salih NA, van Griensven J, Chappuis F, Antierens A, Mumina A, Hammam O, Boulle P, Alirol E, Alnour M, Elhag MS, Manzi M, Kizito W, Zachariah R
- Issue date: 2014 Feb
- Efficacy of liposomal amphotericin B (AmBisome) in the treatment of persistent post-kala-azar dermal leishmaniasis (PKDL).
- Authors: Musa AM, Khalil EA, Mahgoub FA, Hamad S, Elkadaru AM, El Hassan AM
- Issue date: 2005 Sep
- Post Kala-Azar dermal leishmaniasis following treatment with 20 mg/kg liposomal amphotericin B (Ambisome) for primary visceral leishmaniasis in Bihar, India.
- Authors: Burza S, Sinha PK, Mahajan R, Sanz MG, Lima MA, Mitra G, Verma N, Das P
- Issue date: 2014