Sodium stibogluconate and paromomycin for treating visceral leishmaniasis under routine conditions in eastern Sudan. Issue 12 (11th November 2015)

• Record Type: Journal Article
• Authors: Atia, Atia M.; Mumina, Ann; Tayler‐Smith, Katherine; Boulle, Philippa; Alcoba, Gabriel; Elhag, Mousab Siddig; Alnour, Mubarak; Shah, Safieh; Chappuis, François; van Griensven, Johan; Zachariah, Rony
• Is Part Of: Tropical medicine & international health. Volume 20:Issue 12(2015:Dec.)
• Page Start: 1674
• Page End: 1684
• Publication Date: 2015-11-11
• Subjects: Operational Research -- sodium stibogluconate -- paromomycin -- Sudan -- leishmaniasis -- kala‐azar; Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12603
• Languages: English
• ISSNs: 1360-2276

Abstract

Abstract: Objectives: Among patients with primary and relapse visceral leishmaniasis (VL) in eastern Sudan, we determined the proportion eligible for treatment with sodium stibogluconate and paromomycin (SSG/PM) and, of these, their demographic and clinical characteristics; initial treatment outcomes including adverse side effects requiring treatment discontinuation; treatment outcomes by 6 months; and risk factors associated with initial (slow responders) and late treatment failure (relapses and post‐kala‐azar dermal leishmaniasis, PKDL). Methods: A retrospective cohort study in Tabarak Allah Hospital, Gedaref Province, eastern Sudan, from July 2011 to January 2014. Results: Of 1252 individuals diagnosed with VL (1151 primary and 101 relapses), 65% were eligible for SSG/PM including 83% children, almost half of them malnourished and anaemic. About 4% of individuals discontinued treatment due to side effects; 0.7% died during treatment. Initial cure was achieved in 93% of 774 primary cases and 77% of 35 relapse cases ( P < 0.001). Among the 809 patients eligible for SSG/PM, 218 (27%) were lost to follow‐up. Outcomes by six months among the 591 patients with available follow‐up data were: definitive cure ( n = 506; 86%), relapse ( n = 38; 6%), treatment discontinuation ( n = 33; 6%), PKDL ( n = 7; 1%) and death ( n = 7; 1%). Among those completing a full course of SSG/PM, relapses and under‐fives were at significantly higher risk of early and late treatment failure, respectively. Conclusion: Whether SSG/PM as a first‐line regimen is an undeniable progress compared to SSG monotherapy, it excluded a considerable proportion of VL patients due to drug safety concerns. We call for accelerated development of new drugs and treatment regimens to improve VL treatment in Sudan.