Cure of Antimony-Unresponsive Indian Visceral Leishmaniasis with Amphotericin B Lipid Complex
S. Sundar, H. W. Murray
1996
Journal of Infectious Diseases
Twenty-one Indian patients with visceral leishmaniasis who did not respond to or relapsed after 28-60 days of pentavalent antimony therapy were treated with amphotericin B lipid complex (ABLC). Five infusions (3 mg/kg each) given every second day over 9 days (total dose, 15 mglkg) resulted in a 100% apparent cure response. In 4 other patients who had not responded to antimony, apparent cure was also induced by ABLC given at 3 mglkg a day for 5 consecutive days (total dose, 15 mg/kg). Fever and
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... hills developed routinely during the initial 2-h infusions; these reactions were tolerated and diminished with successive infusions. Six months after treatment, all 25 patients were healthy, had parasite-free bone marrow aspirates, and were considered cured. ABLC is effective short-course therapy for kala-azar patients who do not respond to conventional antimony treatment. Increasing clinical experience in patients with visceralleishmaniasis, a disseminated intracellular protozoal infection, suggests that lipid-associated formulations of amphotericin B offer the possibility of short-course therapy for kala-azar with highlevel efficacy [1] [2] [3] [4] . This impression has been supported by results from trials with children and adults in Brazil, Europe, and Sudan using two different intravenous preparations, amphotericin B cholesterol dispersion (Amphocil; Liposome Technology, Menlo Park, CA) [1, 3] and liposomal amphotericin B (AmBisome; Vestar, San Dimas, CA) [2, 4] . In these trials, efficacy was demonstrated clearly in both previously untreated patients [1-3] and in patients who did not respond to conventional pentavalent antimony therapy given alone or in combination with other agents [2, 4] . In India, there is an expanding subset of kala-azar patients who show little or no initial response to pentavalent antimony or who subsequently relapse despite 30-40 days of treatment [5] [6] [7] [8] [9] [10][11]. In such individuals (and in some previously untreated Indian patients as well [9]), clinicians are using prolonged therapy with standard amphotericin B deoxycholate with good results [5, 8, 10, 11]. To more thoroughly test short-course treatment in antimony-refractory Indian kala-azar using amphotericin B in lipid form, we treated 25 such patients with amphotericin B lipid complex (ABLe), a commercially available preparation not previously used for this infection. Patients and Methods Patients. Patients with characteristic clinical signs of active visceral infection and parasites demonstrated on splenic aspirate
doi:10.1093/infdis/173.3.762
pmid:8627049
fatcat:tuisgkriczfdfdscumpe6n2rhe