title: Treatment of visceral leishmaniasis in south-eastern Nepal: decreasing efficacy of sodium stibogluconate and need for a policy to limit further decline.
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.
authors.affiliation: B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Rijal
authors.forename: F
authors.initials: F
authors.lastname: Chappuis
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: P A
authors.initials: PA
authors.lastname: Bovier
authors.forename: P
authors.initials: P
authors.lastname: Acharya
authors.forename: B M S
authors.initials: BM
authors.lastname: Karki
authors.forename: M L
authors.initials: ML
authors.lastname: Das
authors.forename: P
authors.initials: P
authors.lastname: Desjeux
authors.forename: L
authors.initials: L
authors.lastname: Loutan
authors.forename: S
authors.initials: S
authors.lastname: Koirala
mesh_terms: D000328:Adult; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D004351:Drug Resistance; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000981:Antiprotozoal Agents; D000967:Antimony Sodium Gluconate