Treatment of visceral leishmaniasis with sodium stibogluconate in Sudan: management of those who do not respond
Treatment of visceral leishmaniasis with sodium stibogluconate in Sudan: management of those who do not respond
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DOI：
10.1080/00034989859988
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发表时间：
1998-03-01
影响因子：
--
通讯作者：
Ali, MS
中科院分区：
文献类型：
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作者：
Khalil, EAG;El Hassan, AM;Ali, MS
1989至1995年间，苏丹1593名内脏利什曼病(VL)患者中，几乎所有人(98%)都曾在1989年至1995年期间接受戊二糖酸钠(Pentostam(R)；Wellcome)治疗，并进行了随访，治疗效果良好。然而，其余33名HIV血清阴性患者的部分反应或无反应，两个主要原因是原发耐药性(39.3%)和外围药房给药剂量低(30.3%)。当给予足够剂量的药物时，所有未达到最佳剂量的人都被治愈了。第三个原因是并发疾病，特别是肺结核(18%)。在对并发疾病的治疗中，患者对戊四氮的反应良好。8名对重复疗程的戊四氮无效的患者没有从戊双胺或类固醇抑制剂中受益。其中3名患者对脂质体两性霉素B有反应，2名患者在接受脾切除并联合降钙素治疗后有反应，3名患者死亡。在苏丹，给予适当剂量的降钙素似乎仍是治疗VL的首选药物。两性霉素B脂质体是一种合适的二线药物。
Almost all (98%) of 1593 visceral leishmaniasis (VL) patients treated with sodium stibogluconate (Pentostam(R); Wellcome) in Sudan between 1989 and 1995 and followed-up responded well to treatment. However, the other 33 patients, all of whom were seronegative for HIV, showed partial or no response.The two main causes of unresponsiveness were primary drug resistance (39.3%) and low drug dosages given at peripheral dispensaries (30.3%). All of those who had been sub-optimal doses were cured when adequate doses of the drug were given. A third cause was concurrent disease, particularly pulmonary tuberculosis (18%). With treatment of the concurrent disease, patients responded well to Pentostam.Eight patients who failed to respond to repeated courses of Pentostam did not benefit from pentamidine or sterol inhibitors. Three of these patients responded to liposomal amphotericin B, two responded to splenectomy in association with Pentostam therapy, and three died.Pentostam, given in adequate doses, still appears to be the drug of choice for the treatment of VL in the Sudan. Liposomal amphotericin B is a suitable second-line drug.