TREATMENT OF VISCERAL LEISHMANIASIS WITH SODIUM STIBOGLUCONATE IN SUDAN - MANAGEMENT OF THOSE WHO DO NOT RESPOND

Almost all (98%) of 1593 visceral leishmaniasis (VL) patients treated with sodium stibogluconate (Pentostam(R); Wellcome) in Sudan between 1 989 and 1995 and followed-up responded well to treatment. However, the other 33 patients, all of whom were seronegative for HIV, showed part ial or no response. The two main causes of unresponsiveness were prima ry drug resistance (39.3%) and low drug dosages given at peripheral di spensaries (30.3%). All of those who had been sub-optimal doses were c ured when adequate doses of the drug were given. A third cause was con current disease, particularly pulmonary tuberculosis (18%). With treat ment of the concurrent disease, patients responded well to Pentostam. Eight patients who failed to respond to repeated courses of Pentostam did not benefit from pentamidine or sterol inhibitors. Three of these patients responded to liposomal amphotericin B, two responded to splen ectomy in association with Pentostam therapy, and three died. Pentosta m, given in adequate doses, still appears to be the drug of choice for the treatment of VL in the Sudan. Liposomal amphotericin B is a suita ble second-line drug.