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Epidemiology of Drug-Resistant Kala-Azar in India and Neighboring Countries

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Kala Azar in South Asia

Abstract

Sodium stibogluconate (SSG) , a pentavalent antimonial compound, had been the first-line treatment for visceral leishmaniasis (VL) in the Indian subcontinent for more than 70 years, with a cure rate of over 90 %. However, by the year 2000, even a stronger regimen of this treatment failed to cure as many as 60 % of the cases. Among the drugs administered orally, miltefosine was found highly effective in the treatment of VL in different phases of trials in India, with a cure rate of 94, or 82–87 % in outpatients. In the VL elimination program, miltefosine has been used as a first-line drug in India, Nepal, and Bangladesh since 2008. Miltefosine has a long half-life and has been found to be teratogenic in females of child-bearing age. Paromomycin , administered intramuscularly for 21 days, was found to have a cure rate of 94 % in different phases of trials in India. It has been registered in India since August 2006, and is a potential anti-leishmanial drug that is being used in combination therapy . Amphotericin B , or its liposomal compound (AmBisome), remains the most potent drug with a cure rate of 98–100 % in all resistant cases of VL. Since 2015, single dose AmBisome (10 MKD) is being used in the elimination program. To counter the problem of drug resistance , particularly in patients of VL co-infected with HIV , AmBisome in a total dose of 40 MKD in a divided dosage, or a combination therapy of 2 potent drugs, or alternatively, 2 courses of AmBisome, is recommended.

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Acknowledgments

Gratitude is expressed to Mr. Sarvajeet Kumar, Clinical Research Coordinator, Kalazar Research Centre, Brahmpura, Muzaffarpur, for secretarial assistance, and also to Dr. C.P.N. Thakur, Director, Pathological Research Lab, for reviewing the manuscript.

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Authors and Affiliations

  1. Kalazar Research Centre Brahmpura, Muzaffarpur, 842003, Bihar, India

    T. K. Jha

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  1. T. K. Jha
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Correspondence to T. K. Jha .

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  1. The University of Tokyo Hospital, Bunkyō, Tokyo, Japan

    E. Noiri

  2. Kalazar Research Center, Muzaffarpur, India

    T.K. Jha

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Jha, T.K. (2016). Epidemiology of Drug-Resistant Kala-Azar in India and Neighboring Countries. In: Noiri, E., Jha, T. (eds) Kala Azar in South Asia. Springer, Cham. https://doi.org/10.1007/978-3-319-47101-3_4

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