1921
Volume 77, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

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.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2007.77.89
2007-07-01
2017-09-21
Loading full text...

Full text loading...

/deliver/fulltext/14761645/77/1/0770089.html?itemId=/content/journals/10.4269/ajtmh.2007.77.89&mimeType=html&fmt=ahah

References

  1. Zijlstra EE, el-Hassan AM, 2001. Leishmaniasis in Sudan. Visceral leishmaniasis. Trans R Soc Trop Med Hyg 95 (Suppl 1): S27–S58.
  2. Seaman J, Mercer AJ, Sondorp E, 1996. The epidemic of visceral leishmaniasis in western Upper Nile, southern Sudan: course and impact from 1984 to 1994. Int J Epidemiol 25 : 862–871.
  3. Guerin PJ, Olliaro P, Sundar S, Boelaert M, Croft SL, Desjeux P, Wasunna MK, Bryceson AD, 2002. Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda. Lancet Infect Dis 2 : 494–501.
  4. Ritmeijer K, Davidson RN, 2003. Royal Society of Tropical Medicine and Hygiene joint meeting with Medecins sans Frontieres at Manson House, London, 20 March 2003: field research in humanitarian medical programmes. Medecins sans Frontieres interventions against kala-azar in the Sudan, 1989– 2003. Trans R Soc Trop Med Hyg 97 : 609–613.
  5. Seaman J, Pryce D, Sondorp HE, Moody A, Bryceson AD, Davidson RN, 1993. Epidemic visceral leishmaniasis in Sudan: a randomized trial of aminosidine plus sodium stibogluconate versus sodium stibogluconate alone. J Infect Dis 168 : 715–720.
  6. Chunge CN, Owate J, Pamba HO, Donno L, 1990. Treatment of visceral leishmaniasis in Kenya by aminosidine alone or combined with sodium stibogluconate. Trans R Soc Trop Med Hyg 84 : 221–225.
  7. Scott JA, Davidson RN, Moody AH, Grant HR, Felmingham D, Scott GM, Olliaro P, Bryceson AD, 1992. Aminosidine (paromomycin) in the treatment of leishmaniasis imported into the United Kingdom. Trans R Soc Trop Med Hyg 86 : 617–619.
  8. Thakur CP, Olliaro P, Gothoskar S, Bhowmick S, Choudhury BK, Prasad S, Kumar M, Verma BB, 1992. Treatment of visceral leishmaniasis (kala-azar) with aminosidine (= paromomycin)-antimonial combinations, a pilot study in Bihar, India. Trans R Soc Trop Med Hyg 86 : 615–616.
  9. Thakur CP, Bhowmick S, Dolfi L, Olliaro P, 1995. Aminosidine plus sodium stibogluconate for the treatment of Indian kala-azar: a randomized dose-finding clinical trial. Trans R Soc Trop Med Hyg 89 : 219–223.
  10. Thakur CP, Kanyok TP, Pandey AK, Sinha GP, Zaniewski AE, Houlihan HH, Olliaro P, 2000. A prospective randomized, comparative, open-label trial of the safety and efficacy of paromomycin (aminosidine) plus sodium stibogluconate versus sodium stibogluconate alone for the treatment of visceral leishmaniasis. Trans R Soc Trop Med Hyg 94 : 429–431.
  11. Seaman J, Mercer AJ, Sondorp HE, Herwaldt BL, 1996. Epidemic visceral leishmaniasis in southern Sudan: treatment of severely debilitated patients under wartime conditions and with limited resources. Ann Intern Med 124 : 664–672.
  12. World Health Organization, 1996. Manual on Visceral Leishmaniasis Control. Geneva: World Health Organization.
  13. Collin S, Davidson R, Ritmeijer K, Keus K, Melaku Y, Kipngetich S, Davies C, 2004. Conflict and kala-azar: determinants of adverse outcomes of kala-azar among patients in southern Sudan. Clin Infect Dis 38 : 612–619.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2007.77.89
Loading
/content/journals/10.4269/ajtmh.2007.77.89
Loading

Data & Media loading...

  • Received : 29 Sep 2006
  • Accepted : 08 Mar 2007

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error