Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan 056700, Nepal.
Trans R Soc Trop Med Hyg. 2010 Mar;104(3):225-9. doi: 10.1016/j.trstmh.2009.08.002. Epub 2009 Sep 1.
Drug-related factors and parasite resistance have been implicated in the failure of pentavalent antimonials (Sb(v)) in the Indian subcontinent; however, little information is available on host-related factors. Parasitologically confirmed kala-azar patients, treatment naïve to Sb(v), were prospectively recruited at a referral hospital in Nepal and were treated under supervision with 30 doses of quality-assured sodium stibogluconate (SSG) 20mg/kg/day and followed for 12 months to assess cure. Analysis of risk factors for treatment failure was assessed in those receiving >or=25 doses and completing 12 months of follow-up. One hundred and ninety-eight cases were treated with SSG and the overall cure rate was 77.3% (153/198). Of the 181 cases who received >or=25 doses, 12-month follow-up data were obtained in 169, comprising 153 patients (90.5%) with definite cure and 16 (9.5%) treatment failures. In the final logistic regression model, increased failure to SSG was significantly associated with fever for >or=12 weeks [odds ratio (OR)=7.4], living in districts bordering the high SSG resistance zone in Bihar (OR=6.1), interruption of treatment (OR=4.3) and ambulatory treatment (OR=10.2). Early diagnosis and supervised treatment is of paramount importance to prevent treatment failures within the control programme.
药物相关因素和寄生虫耐药性与印度次大陆五价锑（Sb(v)）治疗失败有关；然而，有关宿主相关因素的信息很少。在尼泊尔的一家转诊医院，前瞻性招募了对 Sb(v)治疗初治、寄生虫学确诊的黑热病患者，并在监督下用 30 剂质量保证的葡萄糖酸锑钠（SSG）20mg/kg/天进行治疗，并随访 12 个月以评估治愈情况。在接受 >or=25 剂并完成 12 个月随访的患者中，评估了治疗失败的危险因素分析。用 SSG 治疗了 198 例病例，总治愈率为 77.3%（153/198）。在接受 >or=25 剂的 181 例患者中，有 169 例获得了 12 个月的随访数据，包括 153 例（90.5%）明确治愈和 16 例（9.5%）治疗失败。在最终的逻辑回归模型中，发热 >or=12 周（比值比[OR]=7.4）、居住在比哈尔邦高 SSG 耐药区边界的地区（OR=6.1）、中断治疗（OR=4.3）和门诊治疗（OR=10.2）与 SSG 治疗失败显著相关。早期诊断和监督治疗对于防止控制方案内的治疗失败至关重要。
