TREATMENT OF KALA-AZAR IN BRAZIL WITH AMPHOCIL(R) (AMPHOTERICIN-B CHOLESTEROL DISPERSION) FOR 5 DAYS

We have treated 10 patients suffering from kala-azar in Brazil with Am phocil(R) (amphotericin B cholesterol dispersion) at a dose of 2 mg/kg /d for 5 d, following an earlier study in which this dosage for 7 d wa s found to cure all of 9 patients, with no relapse during 12 months. I n the present study, all patients demonstrated initial resolution of d isease. Parasites were absent upon bone marrow re-aspiration 2 weeks a fter therapy; no spleen extended beyond the costal margin 2 months aft er therapy; white blood cell counts, platelet counts, and serum levels of albumin rapidly returned to normal. Although one patient relapsed at 5 months, 8 of the other 9 patients had spleens of normal size (und etectable on deep palpation) at 12 months after therapy. Fever, someti mes accompanied by increased respiratory rate, occurred on the first d ay of drug infusion in 8 of 10 patients and was more severe in patient s <6 years old. Pre-medication with a non-steroidal anti-inflammatory agent (diclofenac potassium) before the next 4 infusions protected aga inst this side effect in 5 of 6 patients. The results of this and our previous study suggest that the most appropriate regimen of Amphocil(R ) for kala-azar is 2 mg/kg/d for 7 d, with pre-medication each day, in patients aged >5 years.