<div>I fully agree with Manica that it is better to wait the result of the trail on progress before decision as species and host variability greatly influence treatment outcome.</div>
<div> </div>
<div>Regards,</div>
<div> </div>
<div>Abate Mulugeta, Dr</div>
<div>WHO-Ethiopia, NTD/Leish Officer <br><br></div>
<div class="gmail_quote">On Thu, Feb 11, 2010 at 4:07 PM, jeffrey shaw <span dir="ltr"><<a href="mailto:jayusp@hotmail.com">jayusp@hotmail.com</a>></span> wrote:<br>
<blockquote class="gmail_quote" style="PADDING-LEFT: 1ex; MARGIN: 0px 0px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid">
<div>
<p style="FONT-SIZE: 11px; MARGIN-BOTTOM: 5px">Summary and Comment</p>
<h3 style="FONT-WEIGHT: bold; FONT-SIZE: 15px; MARGIN-BOTTOM: 2px">Single-Dose Therapy for Visceral Leishmaniasis</h3>
<p style="FONT-SIZE: 12px; MARGIN-BOTTOM: 10px"><em>A single infusion of liposomal amphotericin B was not inferior to a 15-dose regimen of amphotericin B deoxycholate.</em></p>
<div style="FONT-SIZE: 12px; MARGIN-BOTTOM: 7px">Despite impressive cure rates for several antileishmanial agents, lengthy treatment courses limit the appeal of these therapies. In recent clinical trials, high cure rates have been seen with a 5-day course of liposomal amphotericin B. This finding, coupled with a price reduction for this antimicrobial in developing countries, prompted evaluation of even shorter courses of therapy.<br>
In an open-label trial, 410 patients with visceral leishmaniasis, or kala-azar, were randomized to receive a single infusion of liposomal amphotericin B (10 mg/kg) or 15 alternate-day infusions of amphotericin B deoxycholate (1 mg/kg; conventional therapy). The trial was conducted in northeastern India, which is home to approximately 50% of such patients worldwide. Participants — aged 2 to 65 years — were evaluated at 30 days postenrollment for apparent cure (i.e., absence of fever, clinical improvement, reduction in spleen size, and a splenic-aspirate score of 0) and then at 6 months for cure (being healthy, with no signs or symptoms of relapse).<br>
All 304 patients in the liposomal-therapy group and 106 (98%) of 108 in the conventional-therapy group had apparent cure at 30 days postenrollment. At 6 months, cure rates were similar between groups: 95.7% (95% confidence interval, 93.4%–97.9%) and 96.3% (95% CI, 92.6%–99.9%), respectively. No serious adverse events were reported in either group. The estimated treatment costs were higher for amphotericin B deoxycholate than for liposomal amphotericin B (US$436 vs. $162).<br>
<b>Comment:</b> The availability of a new preferential price agreement for liposomal amphotericin B in developing countries was key in the decision to conduct this trial. The results are impressive and should prompt a reevaluation of current treatment strategies for kala-azar.<br>
<b><i>— <a href="http://infectious-diseases.jwatch.org/misc/board_about.dtl?q=etoc_jwid#aBaddour" target="_blank">Larry M. Baddour, MD</a></i></b><br><i>Published in</i> <a href="http://infectious-diseases.jwatch.org/" target="_blank">Journal Watch Infectious Diseases</a> <i>February 10, 2010</i><br>
</div>
<p style="FONT-WEIGHT: bold; FONT-SIZE: 11px; MARGIN-BOTTOM: 5px">Citation(s):</p><a name="126bd2558fa943fe_ref"></a>
<p style="FONT-SIZE: 11px; MARGIN-BOTTOM: 2px">Sundar S et al. Single-dose liposomal amphotericin B for visceral leishmaniasis in India. <em>N Engl J Med</em> 2010 Feb 11; 362:504.</p></div><br>_______________________________________________<br>
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<br></blockquote></div><br><br clear="all"><br>-- <br>Abate M. Beshah (Dr.)<br>NPO/Leish, WHO<br>+251 (09) 11 401 001<br><a href="mailto:amulugeta001@gmail.com">amulugeta001@gmail.com</a><br>