title: Electrocardiographic changes during treatment of leishmaniasis with pentavalent antimony (sodium stibogluconate).
abstract: Serial electrocardiograms (ECGs) were obtained during 65 courses of sodium stibogluconate treatment in 59 Kenyan patients with leishmaniasis (56 visceral and 3 cutaneous). ECG abnormalities developed during 54% of the treatment courses. The frequency with which abnormalities occurred was related to the total daily dose of antimony (Sb), increasing from 2/9 patients treated with 10 mg Sb/kg/d to 25/48 treated with 20-30 mg Sb/kg/d and 8/8 treated with 40-60 mg Sb/kg/d. The frequency with which ECG abnormalities developed was also related to the duration of treatment, increasing from 11/65 patients after 7 days to 18/44 after 15 days, 26/39 after 30 days and 11/12 after 60 days. ECG abnormalities were similar to those previously described during treatment with trivalent antimonial drugs, the most common being flattening and/or inversion of T waves. Prolongation of the corrected QT interval occurred in 13 patients, all of whom were treated for more than 30 days or with more than 20 mg Sb/kg/d. One patient died suddenly during the fourth week of treatment with 60 mg Sb/kg/d, and 2 patients died of measles after 9 or 10 days of treatment with 30 mg Sb/kg/d. QT prolongation and a concave ST segment developed in all 3 patients who died. We conclude that minor ECG abnormalities are common when sodium stibogluconate is used at doses above 20 mg Sb/kg/d for more than 15 days, and that life-threatening arrhythmias may occur if very high doses are used.
authors.forename: J D
authors.initials: JD
authors.lastname: Chulay
authors.forename: H C
authors.initials: HC
authors.lastname: Spencer
authors.forename: M
authors.initials: M
authors.lastname: Mugambi
mesh_terms: D000293:Adolescent; D000328:Adult; D000967:Antimony Sodium Gluconate / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002648:Child; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005942:Gluconates / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007896:Leishmaniasis / Q000188:drug therapy* / Q000503:physiopathology; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
chemical_list: D005942:Gluconates; D000967:Antimony Sodium Gluconate