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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

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.

Received September 29, 2006. Accepted for publication March 8, 2007.

Acknowledgments: Médecins sans Frontières-Holland thanks the Secretariat of Health of southern Sudan, specifically Dr. Olivia Lomoro Damian, Director of Research, for permission and assistance given to implement this study.

Financial support: This study was supported by Médecins sans Frontières-Holland.

Disclosure: The authors have no conflicts of interest to declare.

^* Address correspondence to Simon M. Collin, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, United Kingdom. E-mail: simon.collin{at}bristol.ac.uk

Authors’ addresses: Yosef Melaku, Kees Keus, Francis Gatluak, and Koert Ritmeijer, Médecins sans Frontières-Holland, Plantage Middenlaan 14, 1018DD Amsterdam, The Netherlands, Telephone: 31-20-520-8700. Fax: 31-20-620-5170, E-mail: koert.ritmeijer{at}amsterdam.msf.org. Simon M. Collin, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK, Telephone: 44-117-331-3934, Fax: 44-117-928-7292, E-mail: simon.collin{at}bristol.ac.uk. Robert N. Davidson, Department of Infection and Tropical Medicine, Lister Unit, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ, UK, Telephone: 44-208-869-2830, Fax: 44-208-869-2836, E-mail: r.n.davidson{at}imperial.ac.uk.

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