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    Mar 03, 2021
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    Treatment options for visceral leishmaniasis: a systematic review of clinical studies done in India, 1980-2004.

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    Authors
    Olliaro, P L
    Guerin, P J
    Gerstl, S
    Haaskjold, A A
    Rottingen, J A
    Sundar, S
    Affiliation
    UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases, WHO, Geneva, Switzerland. olliarop@who.int
    Issue Date
    2005-12
    
    Metadata
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    Journal
    The Lancet Infectious Diseases
    Abstract
    The state of Bihar in India carries the largest share of the world's burden of antimony-resistant visceral leishmaniasis. We analysed clinical studies done in Bihar with different treatments between 1980 and 2004. Overall, 53 studies were included (all but one published), of which 15 were comparative (randomised, quasi-randomised, or non-randomised), 23 dose-finding, and 15 non-comparative. Data from comparative studies were pooled when appropriate for meta-analysis. Overall, these studies enrolled 7263 patients in 123 treatment arms. Adequacy of methods used to do the studies and report on them varied. Unresponsiveness to antimony has developed steadily in the past to such an extent that antimony must now be replaced, despite attempts to stop its progression by increasing dose and duration of therapy. The classic second-line treatments are unsuited: pentamidine is toxic and its efficacy has also declined, and amphotericin B deoxycholate is effective but requires hospitalisation for long periods and toxicity is common. Liposomal amphotericin B is very effective and safe but currently unaffordable because of its high price. Miltefosine-the first oral drug for visceral leishmaniasis-is now registered and marketed in India and is effective, but should be used under supervision to prevent misuse. Paromomycin (or aminosidine) is effective and safe, and although not yet available, a regulatory submission is due soon. To preserve the limited armamentarium of drugs to treat visceral leishmaniasis, drugs should not be deployed unprotected; combinations can make drugs last longer, improve treatment, and reduce costs to households and health systems. India, Bangladesh, and Nepal agreed recently to undertake measures towards the elimination of visceral leishmaniasis. The lessons learnt in Bihar could help inform policy decisions both regionally and elsewhere.
    Publisher
    Elsevier
    URI
    http://hdl.handle.net/10144/66036
    DOI
    10.1016/S1473-3099(05)70296-6
    PubMed ID
    16310148
    Additional Links
    http://www.thelancet.com/journals/laninf
    Type
    Article
    Language
    en
    ISSN
    1473-3099
    Sponsors
    Epicentre
    ae974a485f413a2113503eed53cd6c53
    10.1016/S1473-3099(05)70296-6
    Scopus Count
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