Document Detail


Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal.
MedLine Citation:
PMID:  19726065     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 na?ve 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.
Authors:
S Rijal; S Bhandari; S Koirala; R Singh; B Khanal; L Loutan; J C Dujardin; M Boelaert; F Chappuis
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-09-01
Journal Detail:
Title:  Transactions of the Royal Society of Tropical Medicine and Hygiene     Volume:  104     ISSN:  1878-3503     ISO Abbreviation:  Trans. R. Soc. Trop. Med. Hyg.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-01     Completed Date:  2010-05-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7506129     Medline TA:  Trans R Soc Trop Med Hyg     Country:  England    
Other Details:
Languages:  eng     Pagination:  225-9     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal. sumanrijal2@yahoo.com <sumanrijal2@yahoo.com>
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antimony Sodium Gluconate / administration & dosage*
Antiprotozoal Agents / administration & dosage*
Child
Epidemiologic Methods
Female
Humans
Leishmaniasis, Visceral / drug therapy*,  parasitology
Male
Nepal
Treatment Failure
Young Adult
Chemical
Reg. No./Substance:
0/Antimony Sodium Gluconate; 0/Antiprotozoal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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