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

Rijal, S. ; Chappuis, F. ; Singh, R. ; Bovier, P.A. ; Acharya, P. ; Karki, B.M.S. ; Das, M.L. ; Desjeux, P. ; Loutan, L. ; Koirala, S.

In: Transactions of The Royal Society of Tropical Medicine and Hygiene, 2003, vol. 97, no. 3, p. 350-354

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    Titre
    • Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline
    Auteur
    • Rijal, S.. B. P. Koirala Institute of Health Sciences, Dharan, Nepal
    • Chappuis, F.. Department of Community Medicine, Geneva University Hospital, 1211 Geneva 14, Switzerland
    • Singh, R.. B. P. Koirala Institute of Health Sciences, Dharan, Nepal
    • Bovier, P.A.. Department of Community Medicine, Geneva University Hospital, 1211 Geneva 14, Switzerland
    • Acharya, P.. B. P. Koirala Institute of Health Sciences, Dharan, Nepal
    • Karki, B.M.S.. B. P. Koirala Institute of Health Sciences, Dharan, Nepal
    • Das, M.L.. B. P. Koirala Institute of Health Sciences, Dharan, Nepal
    • Desjeux, P.. Communicable Disease Surveillance and Response (CSR), World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
    • Loutan, L.. Department of Community Medicine, Geneva University Hospital, 1211 Geneva 14, Switzerland
    • Koirala, S.. B. P. Koirala Institute of Health Sciences, Dharan, Nepal
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Transactions of The Royal Society of Tropical Medicine and Hygiene, 2003, vol. 97, no. 3, p. 350-354. Royal Society of Tropical Medicine and Hygiene
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:303206
    Summary
    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