Publication: Visceral leishmaniasis unresponsive to antimonial drugs ii response to high dosage sodium stibogluconate or prolonged treatment with pentamidine
Issued Date
1985-01-01
Resource Type
ISSN
18783503
00359203
00359203
Other identifier(s)
2-s2.0-0022242790
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.79, No.5 (1985), 705-714
Suggested Citation
A. D.M. Bryceson, J. D. Chulay, M. Mugambi, J. B. Were, G. Gachihi, C. N. Chunge, R. Muigai, S. M. Bhatt, M. Ho, H. C. Spencer, J. Meme, G. Anabwan Visceral leishmaniasis unresponsive to antimonial drugs ii response to high dosage sodium stibogluconate or prolonged treatment with pentamidine. Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.79, No.5 (1985), 705-714. doi:10.1016/0035-9203(85)90199-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/30796
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Visceral leishmaniasis unresponsive to antimonial drugs ii response to high dosage sodium stibogluconate or prolonged treatment with pentamidine
Abstract
Ten Kenyan patients with visceral leishmaniasis unresponsive to sodium stibogluconate, at a dose of 16 to 20 mg Sb/kg body-weight/day given for 30 to 98 days, were treated with 20 mg Sb/kg bw given every eight hours. This regimen was modified or abandoned in six patients because of suspected toxicity, although toxicity was difficult to assess because of intercurrent illness. Toxic effects included lethargy, anorexia, vomiting, electrocardiographic changes, fall in haemoglobin and rise in liver enzymes. One patient died, probably from a cardiac arrhythmia. Two patients were cured, four responded partially and four showed no response. Pentamidine, at a dose of 4 mg/kg body-weight given one to 3 times per week for 5 to 39 weeks, was given as initial treatment in one patient and after failure of sodium stibogluconate in seven. Toxic effects included nephritis, hepatitis, transient diabetes and subcutaneous abscesses. Two patients were cured, two responded partially, three showed no response and one, after apparent cure, relapsed and was unresponsive to additional pentamidine treatment. Low-frequency, long-duration pentamidine was often useful in maintaining any improvement made during treatment with the less well tolerated high-dose, high frequency sodium stibogluconate. We observed the step-wise development of resistance to both sodium stibogluconate and pentamidine. The problems of managing patients with visceral leishmaniasis which is unresponsive to conventional doses of pentavalant antimonials are discussed and some tentative suggestions put forward. © Oxford University Press.