Unresponsiveness to AmBisome in some Sudanese patients with kata-azar

In Sudan, two treatments are currently registered for visceral. leishmaniasis: sodium stibogluconate (SSG) as first line and liposomal amphotericin B (AmBisome) as second line. We present 64 patients (52 relapse cases to SSG, 12 new but complicated cases) treated with AmBisome in eastern Sudan. AmBisome was administered at 2.5-8.2 mg/kg (15-49 mg/kg in total) per dose six times (days 1, 2, 3, 5, 10, 15) as an intravenous infusion. We measured outcome according to clinical response and parasitological clearance (lymph node aspiration). Patient outcomes fell into three groups: group 1, clinical responders (cured) with a negative test of cure (n = 35); group 2, clinical responders with a positive test of cure (n = 19); group 3, clinical non-responders (failures) with a positive test of cure (n = 10). Of the 10 failures, six were already relapse cases. All of group 3, and 15 from group 2, were also treated with additional. SSG (20 mg/kg intramuscularly daily for 30-50 d) with resulting clinical and parasitological, improvement. Parasite persistence and clinical. failure were associated with a higher parasite density on admission (P< 0.002) and underlying immunosuppressive disease: tuberculosis (three cases) or HIV (two cases). Because AmBisome monotherapy may fail in Sudan, a combination of AmBisome and SSG is recommended for relapse cases. (C) 2006 Royal Society of Tropical, Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.