Safety and effectiveness of amphotericin B deoxycholate for the treatment of visceral leishmaniasis in Uganda

Authors: Mueller, Y.1; Nguimfack, A.1; Cavailler, P.2; Couffignal, S.1; Rwakimari, J.B.3; Loutan, L.4; Chappuis, F.5

Source: Annals of Tropical Medicine and Parasitology, Volume 102, Number 1, January 2008 , pp. 11-19(9)

Publisher: Maney Publishing

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Abstract:

Between September 2003 and April 2004, the supply of antimonial drugs to Amudat Hospital, in north-eastern Uganda, was interrupted and all cases of visceral leishmaniasis presenting at the hospital could only be treated with amphotericin B deoxycholate (AmB). This allowed the safety and effectiveness of the AmB to be evaluated, in comparison with an historical cohort of patients treated, at the same hospital, with meglumine antimoniate (SbV). Demographic and clinical data were collected before and after treatment. Adverse effects were recorded passively in all the subjects, and actively, using a standardized questionnaire, in a sub-group of the patients given AmB. The in hospital case-fatality 'rates' were 4.8% [95% confidence interval (CI) = 2.4%-8.8%] among the 210 patients treated with AmB and 3.7% (CI = 1.4%-7.9%) among the 161 patients treated with SbV (P>0.20). Adverse effects requiring treatment interruption were rare in both cohorts. Treatment failures (i.e. non-responses or relapses) were observed in 2.9% (CI = 1.2%-6.4%) of the patients treated with AmB and 1.2% (CI = 0.1%-4.4%) of the patients treated with SbV (P>0.20). For the treatment of visceral leishmaniasis in Uganda, AmB therefore had a similar effectiveness and safety profile to that of meglumine antimoniate.

Document Type: Research article

DOI: 10.1179/136485908X252142

Affiliations: 1: Médecins Sans Frontières, Swiss Section, Rue de Lausanne 78, 1202 Geneva, Switzerland 2: Epicentre, 8 Rue Saint-Sabin, 75011 Paris, France 3: Ministry of Health of Uganda, Plot 6 Lourdel Road, Wandegeya, P.O. Box 7272, Kampala, Uganda 4: Travel and Migration Medicine Unit, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland 5: Médecins Sans Frontières, Swiss Section, Rue de Lausanne 78, 1202 Geneva, Switzerland; Travel and Migration Medicine Unit, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland

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