Oral miltefosine in post‐kala‐azar dermal leishmaniasis – experience in three cases

Khandpur, Sujay; Chaturvedi, Pratibha; Kumar, Ujjwal; Khaitan, Binod K.; Samantaray, Jyotish Chandra; Sharma, Vinod

doi:10.1111/j.1365-4632.2010.04326.x

Cited by 8 publications

(4 citation statements)

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“…These findings are of importance as in a previous study of MIL treatment in PKDL cases from 2008–10, no relapse was observed in a 12 months follow up period [ 8 ]. Understandably, relapse has occurred in HIV co-infected individuals [ 15 ] and incomplete cure has been seen with insufficient duration of therapy (50mg twice for 8 weeks) [ 16 ]. On the other hand a few patients may need extended treatment for cure while an occasional patient may be unresponsive [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Decline in Clinical Efficacy of Oral Miltefosine in Treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in India

et al. 2015

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BackgroundRecent studies have shown significant decline in the final cure rate after miltefosine treatment in visceral leishmaniasis. This study evaluates the efficacy of miltefosine in the treatment of post kala-azar dermal leishmaniasis (PKDL) patients recruited over a period of 5 years with 18 months of follow-up.MethodologyIn this study 86 confirmed cases of PKDL were treated with two different dosage regimens of miltefosine (Regimen I- 50mg twice daily for 90 days and Regimen II- 50 mg thrice for 60 days) and the clinical outcome assessed monthly. Cure/relapse was ascertained by clinical and histopathological examination, and measuring parasite burden by quantitative real-time PCR. In vitro susceptibility of parasites towards miltefosine was estimated at both promastigote and amastigote stages.ResultsSeventy three of eighty six patients completed the treatment and achieved clinical cure. Approximately 4% (3/73) patients relapsed by the end of 12 months follow-up, while a total of 15% (11/73) relapsed by the end of 18 months. Relapse rate was significantly higher in regimen II (31%) compared to regimen I (10.5%)(P<0.005). Parasite load at the pre-treatment stage was significantly higher (P<0.005) in cases that relapsed compared to the cases that remained cured. In vitro susceptibility towards miltefosine of parasites isolated after relapse was significantly lower (>2 fold) in comparison with the pre-treatment isolates (P<0.005).ConclusionRelapse rate in PKDL following miltefosine treatment has increased substantially, indicating the need of introducing alternate drugs/ combination therapy with miltefosine.

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Section: Discussionmentioning

confidence: 99%

Decline in Clinical Efficacy of Oral Miltefosine in Treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in India

et al. 2015

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“…The gastrointestinal tract is the main site of side‐effects, 10 which constitute the chief dose‐limiting factor 6,8 . Recently, when the duration of treatment was reduced to 100 mg daily for 8 weeks 11 only one out of three patients achieved complete resolution.…”

Section: Discussionmentioning

confidence: 99%

Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis

Ramesh

Katara

Verma

et al. 2011

British Journal of Dermatology

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“…In recent years, it has been successfully tested in the treatment of protozoal infections, particularly visceral leishmaniasis (Khandpur et al, 2010), American and African trypanosomiases (Santa-Rita et al 2000) and against metronidazole-resistant and metronidazolesusceptible strains of Trichomonas vaginalis (Blaha et al 2006). It has also been tested in vitro against the parasitic amoebas, Entamoeba histolytica (Seifert et al 2001) and freeliving amebas, Acanthamoeba (Walochnik et al 2002;McBride et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of miltefosine for topical treatment of Acanthamoeba keratitis in Syrian hamsters

Polat

Obwaller²,

Vural

et al. 2011

Parasitol Res

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Acanthamoeba keratitis is a painful corneal infection and difficult to treat because no sufficiently efficient drug has yet been available. The aim of the study therefore was to assess the therapeutic potential of miltefosine on Acanthamoeba keratitis-infected hamster eyes. The cornea of hamsters were infected with Acanthamoeba hatchetti, a human corneal isolate. On the fifth day, all the cornea were microscopically examined in order to determine the degree of infections (G, from 0 to 3). Four groups were then prepared: miltefosine (160 μM); 0.1% propamidine isetionate plus 0.02% polyhexnide; infected control (0.05% ethanol in PBS) and a non-infected control (0.05% ethanol in PBS) groups. The treatment was continued for 28 days. After the treatment, the cornea were excised and used for Acanthamoeba culture to investigate the presence of Acanthamoeba growth. Miltefosine treatment yielded much higher cure scores than propamidine isetionate plus polyhexanide. On the last day of treatment, 85% of the miltefosine-treated eyes were graded as G0; no changes were observed in the uninfected control group eyes; G3 eyes showed only a partial improvement. Furthermore, no Acanthamoeba cells could be recovered from the miltefosine-treated eye samples. Miltefosine appeared to hold necessary therapeutic properties for the treatment of Acanthamoeba keratitis.

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Oral miltefosine in post‐kala‐azar dermal leishmaniasis – experience in three cases

Cited by 8 publications

References 20 publications

Decline in Clinical Efficacy of Oral Miltefosine in Treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in India

Decline in Clinical Efficacy of Oral Miltefosine in Treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in India

Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis

Efficacy of miltefosine for topical treatment of Acanthamoeba keratitis in Syrian hamsters

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