Predictors of an unsatisfactory response to pentavalent antimony in the treatment of American visceral leishmaniasis
Rev. Soc. Bras. Med. Trop
;
35(6): 629-633, nov.-dez. 2002. tab
Article
in English
| LILACS
| ID: lil-340063
RESUMO
Although treatment of visceral leishmaniasis with pentavalent antimony is usually successful, some patients require second-line drug therapy, most commonly with amphotericin B. To identify the clinical characteristics that predict an inadequate response to pentavalent antimony, a case-control study was undertaken in Teresina, Piaui, Brazil. Over a two-year period, there were 19 cases of VL in which the staff physicians of a hospital prescribed second-line therapy with amphotericin B after determining that treatment with pentavalent antimony had failed. The control group consisted of 97 patients that were successfully treated with pentavalent antimony. A chart review using univariate and multivariate analysis was performed. The cure rate was 90 percent with amphotericin B. The odds ratio for the prescription of amphotericin B was 10.2 for children less than one year old, compared with individuals aged over 10 years. Patients who presented coinfection had an OR of 7.1 while those on antibiotics had an OR of 2.8. These data support either undertaking a longer course of therapy with pentavalent antimony for children or using amphotericin B as a first-line agent for children and individuals with coinfections. It also suggests that chemoprophylaxis directed toward bacterial coinfection in small children with VL may be indicated
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Amphotericin B
/
Leishmaniasis, Visceral
/
Antimony
/
Antiprotozoal Agents
Type of study:
Observational study
/
Prognostic study
/
Risk factors
Limits:
Adolescent
/
Adult
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Language:
English
Journal:
Rev. Soc. Bras. Med. Trop
Journal subject:
Tropical Medicine
Year:
2002
Type:
Article
/
Project document
Affiliation country:
Brazil
/
United States
Institution/Affiliation country:
Harvard Medical School/US
/
Universidade Federal do Piauí/BR
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