Treatment of Brazilian kala-azar with a short course of amphocil (amphotericin B cholesterol dispersion).
Amphotericin B is an effective but toxic antileishmanial agent. Lipid-encapsulated amphotericin B should have a high therapeutic index for visceral leishmaniasis because reticuloendothelial cells, the sole site in which Leishmania is found, will phagocytize and concentrate the complex. Amphotericin B cholesterol dispersion (Amphocil; 2 mg/[kg.d] intravenously) was administered to 10 Brazilians with kala-azar for 10 days (cohort 1) and to 10 Brazilians with kala-azar for 7 days (cohort 2). All patients were successfully treated: 19 of the 20 patients were without visible parasites in the bone marrow; the mean time to afebrility was 4.2 days; spleen size regressed by a mean of 79% 2 months after therapy; and no patient had clinical or laboratory abnormalities by the end of 6-12 months of follow-up. Side effects were fever and chills accompanied by respiratory distress, but not nephrotoxicity, in children < 3 years of age.
Dietze
R
R
Tropical Medicine Unit, Federal University of Espírito Santo, Vitória, Brazil.
Milan
E P
EP
Berman
J D
JD
Grogl
M
M
Falqueto
A
A
Feitosa
T F
TF
Luz
K G
KG
Suassuna
F A
FA
Marinho
L A
LA
Ksionski
G
G
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D002788:Cholesterol Esters / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D007223:Infant; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000473:pathology
D000981:Antiprotozoal Agents; D002788:Cholesterol Esters; D000666:Amphotericin B