Thakur C P, Sinha G P, Pandey A K, Barat D, Sinha P K
Patna Medical College and Hospital, Bihar, India.
Natl Med J India. 1993 Mar-Apr;6(2):57-60.
During the recent epidemic of kala-azar in Bihar, we identified a group of patients who were unresponsive to the two commonly used drugs--sodium stibogluconate and pentamidine. We evaluated the use of amphotericin B in these patients because it has been shown to be active in experimental animals against amastigotes and promastigotes, it has been found to be useful in South American patients and is now recommended by the World Health Organization as a second line drug.
We selected 300 patients who were unresponsive to sodium stibogluconate and pentamidine (out of 500 patients with kala-azar confirmed by demonstration of Leishmania donovani bodies in their splenic aspirates). Amphotericin B was given in a dose of 1 mg/kg body weight on alternate days starting with 0.05 mg/kg body weight with daily increments till a 1 mg dose was reached. A total dose of 20 mg/kg was given initially and repeated if the parasites persisted. The investigations done before and after treatment were splenic or bone marrow aspiration, measurement of the spleen and liver size, body weight, total and differential white cell counts, haemoglobin level, total serum protein, blood urea, serum creatinine, serum potassium, blood sugar, serum alanine and aspartate transaminase, electrocardiography and a chest X-ray. The efficacy of treatment was assessed at the end of treatment and after 6 months of follow up.
After treatment with amphotericin B, 298 (99%) of the patients had been cured of their disease as evidenced by the disappearance of fever, reduction of hepatosplenomegaly, clearance of the parasites from the spleen and bone marrow and an absence of relapse on 6 months of follow up. Two hundred and sixty-eight (89%) patients required 1 g of the drug, 24 (8%) required 1.5 g and 6 (2%) required 2 g. All patients had shivering and fever during the infusion. Two had a cardiac arrest from which they could not be revived. Other complications included anorexia, stomatitis, jaundice, hypokalaemia and a rise in blood urea. However, these were only mild and improved after treatment was stopped.
Amphotericin B is an effective drug for patients with kala-azar unresponsive to treatment with sodium stibogluconate and pentamidine, but it should be administered under close medical supervision.
在比哈尔邦近期的黑热病疫情期间，我们发现了一组对两种常用药物——葡萄糖酸锑钠和喷他脒无反应的患者。我们评估了两性霉素B在这些患者中的应用，因为它已被证明在实验动物中对无鞭毛体和前鞭毛体有活性，已发现它对南美洲患者有用，并且现在被世界卫生组织推荐作为二线药物。
我们从500例经脾穿刺证实有杜氏利什曼原虫体的黑热病患者中挑选出300例对葡萄糖酸锑钠和喷他脒无反应的患者。两性霉素B的给药剂量为1mg/kg体重，隔日给药，起始剂量为0.05mg/kg体重，每日递增直至达到1mg剂量。最初给予的总剂量为20mg/kg，如果寄生虫持续存在则重复给药。治疗前后进行的检查包括脾或骨髓穿刺、脾脏和肝脏大小测量、体重、白细胞总数和分类计数、血红蛋白水平、总血清蛋白、血尿素、血清肌酐、血清钾、血糖、血清丙氨酸和天冬氨酸转氨酶、心电图和胸部X线检查。在治疗结束时和随访6个月后评估治疗效果。
用两性霉素B治疗后，298例（99%）患者的疾病得到治愈，表现为发热消失、肝脾肿大减轻、脾脏和骨髓中的寄生虫清除以及随访6个月无复发。268例（89%）患者需要1g药物，24例（8%）需要1.5g，6例（2%）需要2g。所有患者在输液期间均出现寒战和发热。2例发生心脏骤停，未能复苏。其他并发症包括厌食、口腔炎、黄疸、低钾血症和血尿素升高。然而，这些仅为轻度，在停止治疗后有所改善。
两性霉素B是治疗对葡萄糖酸锑钠和喷他脒治疗无反应的黑热病患者的有效药物，但应在密切医疗监督下给药。
