TREATMENT OF ANTIMONY-UNRESPONSIVE INDIAN VISCERAL LEISHMANIASIS WITHULTRA-SHORT COURSES OF AMPHOTERICIN-B-LIPID COMPLEX

High cost is the principal drawback of treating visceral leishmaniasis (VL; kala-azar) with any of the new lipid formulations of amphoterici n B. The aim of the present study was to sec if the costs of treatment with such drugs could be reduced by using ultra-short courses. Amphot ericin-B-lipid complex (ABLC) was given to 77 Indian patients with ant imony-unresponsive VL, either as a single infusion of 5 mg/kg (Group A ) or two infusions, each of 5 mg/kg, given 5 days apart (Group B) or o n consecutive days (Group C). Other than the anticipated higher fever and chills, treatment was well tolerated. On day 19 after first infusi on, 72 patients were considered apparent cures: 24 (89%) of the 27 in Group A; all 24 (100%) in Group B; and 24 (92%) of the 26 patients in Group C. Six months after treatment, 19 (70%) of 27 in Group A, 19 (79 %) of 24 in Group B, and 21 (81%) of 26 in Group C were healthy, relap se-free and considered definitive cures. These cure rates were not sta tistically different. All 18 treatment failures (five initial nonrespo nders and 13 relapses) were cured after treatment with a 5-day course of ABLC at a higher dose (10-15 mg/kg.day). In a related analysis of h ospital plus drug costs for treating antimony-unresponsive VL, short-c ourse ABLC (1-5 days) was compared with conventional amphotericin B (0 .75-1.0 mg/kg on alternate days over 30-34 days). This analysis, which included the cost of re-treatment, identified one short-course ABLC r egimen with an overall estimated expense which was only modestly highe r than that of amphotericin B. Together, the present results provide f urther support for the use of ABLC in the management of VL patients wh o fail antimony therapy.