A comparison of liposomal amphotericin B with sodium stibogluconate for the treatment of visceral leishmaniasis in pregnancy in Sudan.
OBJECTIVE
Little is known about the treatment of visceral leishmaniasis (VL) in pregnancy, especially in resource-poor settings. We present a series of pregnant women with VL treated with either sodium stibogluconate or liposomal amphotericin B (AmBisome), or both, in eastern Sudan over 16 months.


METHODS
We did a retrospective analysis of all pregnant VL patients treated in the Médecins sans Frontières (MSF) Um el Kher centre between January 2004 and April 2005. We diagnosed VL with laboratory confirmation of clinical suspects, and recorded the outcomes of treatment for pregnant women and their foetuses. We carried out a manual search of relevant publications and a systematic search of the literature in the MEDLINE database.


RESULTS
We treated 23 women with sodium stibogluconate, 4 with AmBisome and sodium stibogluconate and 12 with AmBisome alone. There were 13 (57%) spontaneous abortions in the sodium stibogluconate monotherapy group, and none in either of the other two groups. All spontaneous abortions occurred in the first two trimesters. All patients, except one in the sodium stibogluconate group who defaulted, were discharged as cured in good clinical condition.


CONCLUSIONS
AmBisome treatment for VL appears to be safe and effective for pregnant women and their foetuses. We recommend the use of AmBisome as first-line treatment for these patients.
Mueller
Marius
M
Médecins sans Frontières, 67-74 Saffron Hill, London EC1N 8QX, UK.
Balasegaram
Manica
M
Koummuki
Youssif
Y
Ritmeijer
Koert
K
Santana
Muriel Ramirez
MR
Davidson
Robert
R
D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000818:Animals; D000967:Antimony Sodium Gluconate / Q000009:adverse effects / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000469:parasitology; D008875:Middle Aged; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000469:parasitology; D013397:Sudan; D016896:Treatment Outcome
D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate