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Title
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Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal
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Author
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Abstract
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| Drug-related factors and parasite resistance have been implicated in the failure of pentavalent antimonials (Sbv) in the Indian subcontinent; however, little information is available on host-related factors. Parasitologically confirmed kala-azar patients, treatment naïve to Sbv, 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. |
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Language
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English
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Source (journal)
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Transactions of the Royal Society of Tropical Medicine and Hygiene. - London
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Publication
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London
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2010
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ISSN
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0035-9203
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DOI
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10.1016/J.TRSTMH.2009.08.002
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Volume/pages
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104
:3
(2010)
, p. 225-229
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ISI
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000276000000009
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Full text (Publisher's DOI)
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