title: Treatment of kala-azar in southern Sudan using a 17-day regimen of sodium stibogluconate combined with paromomycin: a retrospective comparison with 30-day sodium stibogluconate monotherapy.
abstract: Médecins sans Frontières-Holland has treated > 67,000 patients with kala-azar (KA) in southern Sudan since 1989. In 2002, we replaced the standard regimen of 30 days of daily sodium stibogluconate (SSG) with a 17-day regimen of daily SSG combined with paromomycin (PM). We analyzed data for 4,263 primary KA patients treated between 2002 and 2005 in southern Sudan to determine the relative efficacy of the combination therapy regimen (PM/SSG). The initial cure rate among patients treated with PM/SSG was 97.0% compared with 92.4% among patients treated with SSG monotherapy. Relative efficacy of PM/SSG compared with SSG increased over the study period: odds of death in the PM/SSG group were 44% lower (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.37-0.84) in 2002, 78% lower (OR = 0.22, 95% CI = 0.10-0.50) in 2003, and 86% lower (OR = 0.14, 95% CI = 0.07-0.27) in 2004-2005. In remote field settings, 17 days of SSG combined with PM gives better survival and initial cure rates than 30 days of SSG monotherapy.
authors.affiliation: Médecins sans Frontières-Holland, Amsterdam, The Netherlands.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Melaku
authors.forename: Simon M
authors.initials: SM
authors.lastname: Collin
authors.forename: Kees
authors.initials: K
authors.lastname: Keus
authors.forename: Francis
authors.initials: F
authors.lastname: Gatluak
authors.forename: Koert
authors.initials: K
authors.lastname: Ritmeijer
authors.forename: Robert N
authors.initials: RN
authors.lastname: Davidson
mesh_terms: D000293:Adolescent; D000967:Antimony Sodium Gluconate / Q000008:administration & dosage*; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008499:Medical Records; D010303:Paromomycin / Q000008:administration & dosage*; D012189:Retrospective Studies; D013397:Sudan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; D010303:Paromomycin; D000967:Antimony Sodium Gluconate