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Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal

Rijal, S. ; Bhandari, S. ; Koirala, S. ; Singh, R. ; Khanal, B. ; Loutan, L. ; Dujardin, J.C. ; Boelaert, M. ; Chappuis, F.

In: Transactions of The Royal Society of Tropical Medicine and Hygiene, 2010, vol. 104, no. 3, p. 225-229

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    Titre
    • Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal
    Auteur
    • Rijal, S.. Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal
    • Bhandari, S.. Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal
    • Koirala, S.. Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal
    • Singh, R.. Department of Paediatrics, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal
    • Khanal, B.. Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal
    • Loutan, L.. Division of International and Humanitarian Medicine, Geneva University Hospitals 6, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
    • Dujardin, J.C.. Department of Parasitology, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
    • Boelaert, M.. Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
    • Chappuis, F.. Division of International and Humanitarian Medicine, Geneva University Hospitals 6, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Transactions of The Royal Society of Tropical Medicine and Hygiene, 2010, vol. 104, no. 3, p. 225-229. Royal Society of Tropical Medicine and Hygiene
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:297641
    Summary
    Drug-related factors and parasite resistance have been implicated in the failure of pentavalent antimonials (Sbv) in the Indian subcontinent; however, little information is available on host-related factors. Parasitologically confirmed kala-azar patients, treatment naïve to Sbv, were prospectively recruited at a referral hospital in Nepal and were treated under supervision with 30 doses of quality-assured sodium stibogluconate (SSG) 20 mg/kg/day and followed for 12 months to assess cure. Analysis of risk factors for treatment failure was assessed in those receiving ≥25 doses and completing 12 months of follow-up. One hundred and ninety-eight cases were treated with SSG and the overall cure rate was 77.3% (153/198). Of the 181 cases who received ≥25 doses, 12-month follow-up data were obtained in 169, comprising 153 patients (90.5%) with definite cure and 16 (9.5%) treatment failures. In the final logistic regression model, increased failure to SSG was significantly associated with fever for ≥12 weeks [odds ratio (OR) = 7.4], living in districts bordering the high SSG resistance zone in Bihar (OR = 6.1), interruption of treatment (OR = 4.3) and ambulatory treatment (OR = 10.2). Early diagnosis and supervised treatment is of paramount importance to prevent treatment failures within the control programme