Epidemiology of Drug-Resistant Kala-Azar in India and Neighboring Countries

摘要: Sodium stibogluconate (SSG), a pentavalent antimonial compound administered parenterally at daily dose of 10 mg/kg for days has been the first-line treatment kala-azar on Indian subcontinent more than 70 years, with cure rate > 90%. However, in 1970s and early 1980s this regimen failed to an appreciable percentage cases from hyper endemic state Bihar. In 1982 1990, World Health Organization recommended higher prolonged dosage use resistant zones kala-azar. But by year 2000, even these stronger treatments as many 60% cases. Even districts Nepal bordering Bihar, efficacy declined 59.9%. Diamidine compounds were used extensively SSG-resistant Bihar between late 2003. The when 10–12 injections given remained 98.2% until 1980s. 1990s longer was required, while incidence serious toxicities increased. Thus, drug discontinued. Among drugs orally, miltefosine found highly effective different phases trials India, 94%. 82–87% outpatients. Paromomycin, intramuscularly 21 days, have 94% India. It registered India since August 2006, is potential drug. Amphotericin B or its liposomal (AmBisome) remains most potent 98–100% all To counter problem resistance, particularly patients co-infected HIV, combination therapy two alternatively courses AmBisome recommended.