Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal.
Drug-related factors and parasite resistance have been implicated in the failure of pentavalent antimonials (Sb(v)) in the Indian subcontinent; however, little information is available on host-related factors. Parasitologically confirmed kala-azar patients, treatment naïve to Sb(v), were prospectively recruited at a referral hospital in Nepal and were treated under supervision with 30 doses of quality-assured sodium stibogluconate (SSG) 20mg/kg/day and followed for 12 months to assess cure. Analysis of risk factors for treatment failure was assessed in those receiving >or=25 doses and completing 12 months of follow-up. One hundred and ninety-eight cases were treated with SSG and the overall cure rate was 77.3% (153/198). Of the 181 cases who received >or=25 doses, 12-month follow-up data were obtained in 169, comprising 153 patients (90.5%) with definite cure and 16 (9.5%) treatment failures. In the final logistic regression model, increased failure to SSG was significantly associated with fever for >or=12 weeks [odds ratio (OR)=7.4], living in districts bordering the high SSG resistance zone in Bihar (OR=6.1), interruption of treatment (OR=4.3) and ambulatory treatment (OR=10.2). Early diagnosis and supervised treatment is of paramount importance to prevent treatment failures within the control programme.
Rijal
S
S
Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal. sumanrijal2@yahoo.com <sumanrijal2@yahoo.com>
Bhandari
S
S
Koirala
S
S
Singh
R
R
Khanal
B
B
Loutan
L
L
Dujardin
J C
JC
Boelaert
M
M
Chappuis
F
F
D000293:Adolescent; D000328:Adult; D000967:Antimony Sodium Gluconate / Q000008:administration & dosage*; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D009390:Nepal; D017211:Treatment Failure; D055815:Young Adult
D000981:Antiprotozoal Agents; D000967:Antimony Sodium Gluconate