Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 104; no. 3; pp. 225 - 229
• Main Authors: Rijal, S., Bhandari, S., Koirala, S., Singh, R., Khanal, B., Loutan, L., Dujardin, J.C., Boelaert, M., Chappuis, F.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.03.2010; Royal Society of Tropical Medicine and Hygiene; Oxford University Press
• Subjects: Adolescent; Adult; Antimony Sodium Gluconate - administration & dosage; Antiprotozoal Agents - administration & dosage; Biological and medical sciences; Child; Control programme; Epidemiologic Methods; Female; General aspects; Human protozoal diseases; Humans; Infectious diseases; Kala-azar; Leishmaniasis, Visceral - drug therapy; Leishmaniasis, Visceral - parasitology; Leshmaniasis; Male; Medical sciences; Nepal; Parasitic diseases; Pentavalent antimonials; Protozoal diseases; Risk factors; Therapeutic failure; Treatment Failure; Young Adult; Asia; Nepal; Kala-azar; Pentavalent antimonials; Therapeutic failure; Risk factors; Nepal; Control programme; Human; Protozoal disease; Kala azar; Leishmaniasis; Parasitosis; Infection; Sanitary control; Treatment; Risk factor; Tropical medicine; Failure
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/j.trstmh.2009.08.002

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 naïve 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) 20 mg/kg/day and followed for 12 months to assess cure. Analysis of risk factors for treatment failure was assessed in those receiving ≥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 ≥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 ≥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.