1921
Volume 83, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Complications of amphotericin B limit its wide application in the treatment of patients with kala-azar. This study was undertaken with an aim to minimize anti-renal complications and severe rigor in course of treatment with this drug. Parasitologically confirmed kala-azar cases (n = 230) were randomized equally into two groups: a control group received amphotericin B only at a dose of 1 mg/kg of body weight/day for 20 days and a patient (test) group received 500 mL of physiologic saline and 30 mL (60 meq/L) of KC1 with amphotericin B. We observed a significantly lower increase in serum creatinine levels ( = 0.0001) and a lower incidence of severe rigor and fever ( = 0.0165) in the test group than in the control group. However, the ultimate cure rate was not significantly different ( = 0.5637) between two groups after 12 months of follow-up. Relapses occurred after even after six months in both groups. Persons with relapses were treated with 25 infusions of amphotericin B and cured. Supplementation of amphotericin B with 500 mL of physiologic saline and 30 mL (60 meq/L) of KCl during treatment could help prevent an increase in serum creatinine levels and severe rigor and would make the treatment of kala-azar with amphotericin B easier.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2010.10-0255
2010-11-05
2020-11-25
Loading full text...

Full text loading...

/deliver/fulltext/14761645/83/5/1040.html?itemId=/content/journals/10.4269/ajtmh.2010.10-0255&mimeType=html&fmt=ahah

References

  1. Prata A, 1963. Treatment of kala-azar with amphotericin B. Trans R Soc Trop Med Hyg 57: 266268.[Crossref]
    [Google Scholar]
  2. Thakur CP, 1993. Diminishing effectiveness of currently used drugs in treatment of kala-azar and amphotericin B in antimony and pentamidine resistant kala-azar. Kumar S, ed. Current Trends in Leishmania Research. New Delhi, India: Council of Scientific and Industrial Research, India: 254262.
    [Google Scholar]
  3. Mishra M, Singh MP, Choudhury D, Singh VP, Khan AP, 1991. Amphotericin B for second line treatment of Indian kala-azar. Lancet 337: 926.[Crossref]
    [Google Scholar]
  4. Lira R, Sundar S, Makharia A, Keeny R, Gam A, Saraiva E, Sack D, 1999. Evidence that the high incidence of treatment failure in kala-azar is due to the emergence of antimony resistant strains of Leshmania donovani . J Infect Dis 180: 564567.[Crossref]
    [Google Scholar]
  5. Thakur CP, Sinha SP, Sharma V, Pandey AK, Kumar M, Verma BB, 1993. Evaluation of amphotericin B as a first line drug in comparison to sodium stibogluconate in the treatment of fresh cases of kala-azar. Indian J Med Res 97: 170175.
    [Google Scholar]
  6. Thakur CP, Kumar A, Mitra G, Thakur S, Sinha PK, Das P, Bhattacharya SK, Sinha A, 2008. Impact of amphotericin B in the treatment of kala-azar on the incidence of PKDL in Bihar, India. Indian J Med Res 128: 5864.
    [Google Scholar]
  7. Saha S, Mondal S, Ravindran R, Bhowmick S, Modak D, Mallick S, Rahman M, Kar S, Goswami R, Guha SK, Pramanik N, Saha B, Ali N, 2007. IL-10- and TGF-β-mediated susceptibility in kala-azar and post-kala-azar dermal leishmaniasis: the significance of amphotericin B in the control of Leishmania donovani infection in India. J Immunol 179: 55925603.[Crossref]
    [Google Scholar]
  8. Gallis HA, Drew RH, Pickard WW, 1990. Amphotericin B. 30 years of clinical experience. Rev Infect Dis 12: 308329.[Crossref]
    [Google Scholar]
  9. Bindschadler DD, Bennett JE, 1969. A pharmacological guide to the clinical use of amphotericin B. J Infect Dis 120: 427436.[Crossref]
    [Google Scholar]
  10. Khoo SH, Bond J, Denning DW, 1994. Administering amphotericin B – a practical approach. J Antimicrob Chemother 33: 203213.[Crossref]
    [Google Scholar]
  11. Thakur CP, 1995. Correction of serum electrolyte imbalance prevents cardiac arrhythmia during amphotericin B administration. Natl Med J India 8: 1314.
    [Google Scholar]
  12. Thakur CP, 1998. Sodium antimony gluconate, amphotericin, and myocardial damage. Lancet 27: 19281929.[Crossref]
    [Google Scholar]
  13. Nuzum E, White F III, Thakur CP, Dietze R, Wages J, Grogl M, Berman J, 1995. Diagnosis of symptomatic visceral leishmaniasis by use of the polymerase chain reaction on patient blood. J Infect Dis 171: 751754.[Crossref]
    [Google Scholar]
  14. Thakur CP, Sinha GP, Pandey AK, 1996. Comparison of regimens of amphotericin B deoxycholate in kala-azar. Indian J Med Res 103: 259263.
    [Google Scholar]
  15. Jha TK, Giri YN, Singh TK, Jha S, 1995. Use of amphotericin in drug resistant cases of visceral leishmaniasis in North Bihar, India. Am J Trop Med Hyg 52: 336538.
    [Google Scholar]
  16. Thakur CP, Singh RK, Hassan SM, Kumar R, Narain S, Kumar A, 1999. Amphotericin B deoxycholate treatment of visceral leishmaniasis with newer modes of administration and precautions: a study of 938 cases. Trans R Soc Trop Med Hyg 93: 319323.[Crossref]
    [Google Scholar]
  17. Bhattacharya SK, Sinha PK, Thakur CP, Jha TK, Pandey K, Das VR, Kumar N, Lal C, Verma N, Singh VP, Ranjan A, Verma RB, Anders G, Sindermann H, Ganguly NK, 2007. Phase-4 trial of miltefosine for the treatment of Indian visceral leishmaniasis. J Infect Dis 196: 591598.[Crossref]
    [Google Scholar]
  18. Sundar S, Jha TK, Thakur CP, Sinha PK, Bhattacharya SK, 2007. Injectable paromomycin for visceral leishmaniasis in India. N Engl J Med 356: 25712581.[Crossref]
    [Google Scholar]
  19. Fisher Exact Test, 1998. Available at: http://hedwig.mgh.harvard.edu/sample_size/fisher/fishapp.html.
  20. Medical Journal of Australia, 2002. Determining the Sample Size in a Clinical Trial. Available at: http://www.mja.com.au/public/issues/177_05_020902/kir10425_fm.html.
    [Google Scholar]
  21. Chulay JD, Bryceson AD, 1983. Quantitation of amastigotes of Leishmania donovani in smears of splenic aspirates from patients with visceral leishmaniasis. Am J Trop Med Hyg 32: 475479.
    [Google Scholar]
  22. Cancer Therapy Evaluation Program, Common Toxicity Criteria. Rockville, MD: National Cancer Institute, 2002. Available at: http://ctep.cancer.gov/reporting/index.html Accessed December 7, 2003.
    [Google Scholar]
  23. Sundar R, Rai M, 2002. Advances in the treatment of visceral leishmaniasis. Curr Opin Infect Dis 15: 593598.[Crossref]
    [Google Scholar]
  24. Sundar S, Chatterjee M, 2006. Visceral leishmaniasis—current therapeutic modalities. Indian J Med Res 123: 345352.
    [Google Scholar]
  25. Bailey JE, Meyers C, Keigman RM, 1990. Pharmacokinetics; outcome of treatment and toxic effects of amphotericin B and 5 flucytosine in neonates. J Pediatr 116: 791.[Crossref]
    [Google Scholar]
  26. Ramakant B, Kala-Azar Patients Lack Adequate Diagnosis and Drug. February 5th, 2009 - 8:59 pm ICT by admin. Available at: http://www.thaindian.com/newsportal/health/kala-azar-patients-lack-adequate-diagnosis-and-drugs_10015619.html.
    [Google Scholar]
  27. Thakur CP, 2007. A new strategy for elimination of kala-azar from rural Bihar. Indian J Med Res 126: 447451.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2010.10-0255
Loading
/content/journals/10.4269/ajtmh.2010.10-0255
Loading

Data & Media loading...

  • Received : 04 May 2010
  • Accepted : 22 Jul 2010
  • Published online : 05 Nov 2010
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