Increasing failure of miltefosine in the treatment of kala-azar in Nepal and the potential role of parasite drug resistance, re-infection or non-compliance

S. Rijal, B. Ostyn, S. Uranw, K. Rai, N.R. Bhattarai, T.P. Dorlo, J.H. Beijnen, M. Vanaerschot, S. Decuypere, S.S. Dhakal, M.L. Das, P. Karki, R. Singh, M. Boelaert, J.C. Dujardin

Research output: Contribution to journalA1: Web of Science-article

Abstract

Background. Miltefosine (MIL), the only oral drug for visceral leishmaniasis (VL), is currently the 1(st) line therapy in the VL elimination program of the Indian subcontinent. Given the paucity of anti-VL drugs and the looming threat of resistance, there is an obvious need for close monitoring of clinical efficacy of MIL. Methods. In a cohort study of 120 VL patients treated with MIL in Nepal, we monitored the clinical outcomes up to 12 after completion of therapy and explored the potential role of drug compliance, parasite drug resistance and re-infection. Results. The initial cure rate was 95.8% (95% C.I. +/-3.6%)and relapse rate at six and twelve months was 10.8% (95% C.I.+/-5.6%) and 20.0% (95% C.I.+/-7.2%) respectively. No significant clinical risk factors of relapse apart from age
Original languageEnglish
JournalClinical Infectious Diseases
Volume56
Issue number11
Pages (from-to)1530-1538
Number of pages9
ISSN1058-4838
DOIs
Publication statusPublished - 2013

Keywords

  • Protozoal diseases
  • Kala azar
  • Visceral
  • Leishmaniasis
  • Leishmania donovani
  • Vectors
  • Sandflies
  • Control programs
  • Mass drug therapy
  • Drug resistance
  • Miltefosine
  • Reinfection
  • Treatment failure
  • Compliance
  • Relapses
  • Nepal
  • Asia-South

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