Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline

Trans R Soc Trop Med Hyg. May-Jun 2003;97(3):350-4. doi: 10.1016/s0035-9203(03)90167-2.

Abstract

Sodium stibogluconate (SSG) is the first-line therapy for visceral leishmaniasis (VL) in south-eastern Nepal. Recent studies from the neighbouring state of Bihar, India, have shown a dramatic fall in cure rates with treatment failure occurring in up to 65% of VL patients treated with SSG. A prospective study was conducted at a tertiary-level hospital located in south-eastern Nepal from July 1999 to January 2001. Parasitologically proven kala-azar patients with no previous history of treatment for VL were treated with SSG 20 mg/kg/d for 30 d which was extended to 40 d in those with persistent positive parasitology. Of the 110 patients who completed SSG therapy and were assessed at 1 and 6 months, definite cure was achieved in 99 patients (90%) and SSG failure occurred in 11 patients (10%). Except for the presence of hepatomegaly and a lower platelet count there was no clinical or laboratory baseline characteristic associated with treatment failure. A significantly lower cure rate (76%, P = 0.03) was observed in patients from the district of Saptari, which borders the antimony-resistant VL areas of Bihar. The efficacy of SSG as a first-line treatment for VL in south-eastern Nepal was still satisfactory, except for the patients living closer to the antimony-resistant VL areas of India. These findings indicate that the spread of resistance to antimonials is already taking place in Nepal and that a policy to control further spread should be urgently implemented.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antimony Sodium Gluconate / therapeutic use*
  • Antiprotozoal Agents / therapeutic use*
  • Drug Resistance
  • Endemic Diseases
  • Female
  • Humans
  • Leishmaniasis, Visceral / drug therapy*
  • Leishmaniasis, Visceral / epidemiology
  • Male
  • Middle Aged
  • Nepal / epidemiology
  • Prospective Studies
  • Risk Factors
  • Treatment Failure

Substances

  • Antiprotozoal Agents
  • Antimony Sodium Gluconate