Treatment of visceral leishmaniasis (kala-azar) with aminosidine (= paromomycin)-antimonial combinations, a pilot study in Bihar, India

Abstract

A 20 d drug regimen of aminosidine (= paromomycin) at 12 mg/kg/d in combination with sodium stibogluconate at 20 mg/kg/d proved efficacious and well-tolerated in patients with visceral leishmaniasis in the State of Bihar, India. Eighteen of 22 evaluable patients achieved an ultimate cure. The remaining 4 patients, although not cleared of parasites, had their parasite grade reduced and also improved clinically. This confirms prior findings in Kenyan patients with kala-azar, and indicates that this regimen is a valid alternative to antimonial compounds alone in the State of Bihar, where cases of kala-azar not responding to antimonial drugs and intolerant of pentamidine are increasingly recorded.

Treatment options for visceral leishmaniasis: a systematic review of clinical studies done in India, 1980–2004

“…12,14,15,58,59 Three of them were comparative against antimony alone (20 mg/kg per day for 30 days), one dose-finding, and one non-comparative (table 7). All comparative and dose-finding studies used computer-generated randomisation; methods to conceal allocation were used in two.…”

Differential Effects of Paromomycin on Ribosomes of Leishmania mexicana and Mammalian Cells

“…Among them, paromomycin (aminosidine) has shown antileishmanial activity when used alone or in combination with other drugs (7,10,17,18,20). Topical treatments with paromomycin-containing ointments or intramuscular injections of the same antibiotic have been successfully used for a long time against cutaneous or visceral leishmaniasis, respectively (7,23,32,34). However, very little is known about the differential effects of the drug on parasites and mammalian host cells.…”

Therapeutic switching in leishmania chemotherapy: a distinct approach towards unsatisfied treatment needs

“…In 1991, a massive epidemic of VL occurred in western Upper Nile province in south Sudan. To combat this situation a humanitarian medical agency Médecins Sans Frontières (MSF) decided to evaluate a short-course combination of paromomycin plus SSG, which was by then also being studied in India by the WHO/TDR (Thakur et al 1992). Seaman et al (1993) conducted a randomised controlled trial of combination of paromomycin sulphate 15 mg/kg/day plus SSG 20 mg/kg/ day, i.m., daily for 17 days on 200 Sudanese VL patients and were found to be as effective as SSG monotherapy, with a lower mortality.…”