Mishra M, Biswas U K, Jha A M, Khan A B
Darbhanga Medical College and Hospital, Bihar, India.
Lancet. 1994 Dec 10;344(8937):1599-600. doi: 10.1016/s0140-6736(94)90406-5.
Patients do not always respond to treatment of visceral leishmaniasis with pentavalent antimony, and the drug has toxic effects. Amphotericin B might be useful as an alternative first-line treatment for the disease. We compared the efficacy of amphotericin and sodium stibogluconate in a prospective randomised trial in 80 uncomplicated and parasitologically confirmed cases of Indian kala-azar. None of the patients had received an antileishmanial agent before. Sodium stibogluconate was given at 20 mg/kg in two divided doses daily for 40 days, and amphotericin in fourteen doses of 0.5 mg/kg infused in 5% dextrose on alternate days. All 40 patients randomised to amphotericin were cured; of the 40 patients assigned to sodium stibogluconate, 28 (70%) showed initial cure and 25 (62.5%) showed definitive cure (p < 0.001). With amphotericin, there was quicker abatement of fever and more complete spleen regression with no serious adverse effects. Amphotericin is effective in the first-line treatment of Indian kala-azar and superior to antimony therapy.
患者对内脏利什曼病采用五价锑治疗时并不总是有反应，且该药物有毒性作用。两性霉素B可能作为该病的替代一线治疗药物有用。我们在一项前瞻性随机试验中比较了两性霉素和葡萄糖酸锑钠对80例未并发且经寄生虫学确诊的印度黑热病病例的疗效。所有患者此前均未接受过抗利什曼原虫药物治疗。葡萄糖酸锑钠按20mg/kg每日分两次给药，共40天，两性霉素分14次，每次0.5mg/kg，隔日溶于5%葡萄糖中输注。随机接受两性霉素治疗的40例患者均治愈；在分配接受葡萄糖酸锑钠治疗的40例患者中，28例（70%）初步治愈，25例（62.5%）最终治愈（p<0.001）。使用两性霉素时，发热消退更快，脾脏回缩更完全，且无严重不良反应。两性霉素对印度黑热病一线治疗有效且优于锑剂治疗。
