antimony-sodium-gluconate and Pancreatitis

The recommended treatment for cutaneous leishmaniasis is pentavalent antimony at a dosage of 20 mg/kg/day for 20 days. Some studies conducted in locales in which Leishmania is endemic have suggested that shorter courses of treatment may be as efficacious. We conducted a randomized, double-blind, placebo-controlled study of 10 versus 20 days of sodium stibogluconate (SSG) in United States military personnel who contracted cutaneous leishmaniasis while serving overseas; 19 patients received SSG for 10 days (and placebo for 10 days), and 19 patients received SSG for 20 days. Cure rates were 100% (19 of 19 patients) in the 10-day group and 95% (18 of 19 patients) in the 20-day group. Side effects were more common among patients who received 20 days of therapy. In this group of otherwise healthy young adults, SSG at a dosage of 20 mg/kg/day for 10 days appears to have been therapeutically equivalent and less toxic than the standard 20-day course.

Topics: Adult; Antimony Sodium Gluconate; Antiprotozoal Agents; Arthralgia; Double-Blind Method; Drug Administration Schedule; Follow-Up Studies; Humans; Leishmaniasis, Cutaneous; Male; Middle Aged; Military Personnel; Pancreatitis; Treatment Outcome; United States

The efficacy and toxicity of sodium stibogluconate (SSG) at a dosage of 20 mg/(kg.d) for either 20 days (for cutaneous disease) or 28 days (for visceral, mucosal, or viscerotropic disease) in the treatment of leishmaniasis is reported. Ninety-six U.S. Department of Defense health care beneficiaries with parasitologically confirmed leishmaniasis were prospectively followed for 1 year. One patient was infected with human immunodeficiency virus; otherwise, comorbidity was absent. Clinical cure occurred in 91% of 83 cases of cutaneous disease and 93% of 13 cases of visceral/viscerotropic disease. Adverse effects were common and necessitated interruption of treatment in 28% of cases, but they were generally reversible. These included arthralgias and myalgias (58%), pancreatitis (97%), transaminitis (67%), headache (22%), hematologic suppression (44%), and rash (9%). No subsequent mucosal leishmaniasis was identified, and there were no deaths attributable to SSG or leishmaniasis.

Topics: Adolescent; Adult; Antimony Sodium Gluconate; Antiprotozoal Agents; Headache; Humans; Injections, Intravenous; Leishmaniasis; Male; Middle Aged; Military Personnel; Pancreatitis; Treatment Outcome

Topics: Antimony Sodium Gluconate; HIV Infections; Humans; Leishmaniasis, Visceral; Pancreatitis; Schistosomicides

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Antimony Sodium Gluconate; Antiprotozoal Agents; Female; Humans; Leishmaniasis, Visceral; Pancreatitis

Acute pancreatitis is an adverse effect of the treatment with antimonial drugs which is infrequently described in patients with HIV infection and visceral leishmaniasis (VL). Twenty-two percent of the patients having this treatment had acute pancreatitis (7 cases) in the authors' center. In all the cases, severe immunosuppression was present with pancreatitis appearing following the administration of 3,400 to 15,300 mg of stibogluconate. The pancreatitis was slight in the 7 cases with no complications of note and with no symptoms observed in three cases. The maximum values of amylasemia ranged from 976 to 2,568 U/l, from 1,055 to 5,860 U/l for lipasemia, and from 1,970 to 25,520 U/l for trypsinemia. These values returned to normal from 15 days to 2 months after suppression of the drug. Stibogluconate was readministered in three patients due to VL recurrence with a further acute pancreatitis being observed. The authors conclude that acute pancreatitis is a relatively infrequent complication of antimonial treatment for VL in patients with HIV infection and believe that a maximum dose of 850 mg/day should not be surpassed.

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Antimony Sodium Gluconate; Antiprotozoal Agents; Clinical Enzyme Tests; Female; HIV-1; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Pancreatitis; Recurrence

Topics: Acute Disease; Adult; Amphotericin B; Antimony Sodium Gluconate; Female; HIV Infections; Humans; Leishmaniasis, Visceral; Pancreatitis

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Amylases; Animals; Antimony Sodium Gluconate; Humans; Leishmania infantum; Leishmaniasis, Visceral; Male; Necrosis; Pancreas; Pancreatitis

Pentavalent antimony (Sbv), formulated as sodium stibogluconate or meglumine antimoniate, is the standard treatment for the leishmaniases. In 16 of 17 consecutive, prospectively observed patients in Washington D.C., serum levels of amylase and lipase rose to abnormal values after therapy with sodium stibogluconate was started; 12 of 17 had symptoms of pancreatitis. Sbv therapy was continued to completion in 7 of 17 patients and interrupted in 10 of 17. Pancreatitis improved in every patient after Sbv therapy was stopped. Sbv treatment was resumed after brief interruptions in 6 of 10 patients. All six of these patients had flares of pancreatitis, but each completed therapy. Subsequently, we measured amylase and lipase levels in stored sera from 32 patients treated in Peru with either sodium stibogluconate or meglumine antimoniate for mucosal leishmaniasis. In all 32 Peruvian patients, serum amylase and lipase rose to abnormal levels during Sbv therapy; 11 of 32 had symptoms of pancreatitis. Standard Sbv regimens induce pancreatitis in almost all patients, but continued therapy is often tolerated; pancreatitis subsides when therapy is stopped, and rechallenge may be tolerated after a brief halt in treatment.

Topics: Adult; Amylases; Antimony Sodium Gluconate; Antiprotozoal Agents; District of Columbia; Humans; Leishmaniasis, Mucocutaneous; Leishmaniasis, Visceral; Lipase; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Pancreatitis; Peru; Prospective Studies

Topics: Adult; AIDS-Related Opportunistic Infections; Antimony Sodium Gluconate; Humans; Immunocompetence; Leishmaniasis; Male; Pancreatitis

A case of a renal transplant recipient who developed pancreatitis during stibogluconate treatment for visceral leishmaniasis and who was successfully treated with a combination of allopurinol and ketoconazole is reported. The features of this case are compared with those of the three previously reported cases of pancreatitis during stibogluconate treatment. Complete cure was achieved during the follow-up period of 15 months. If stibogluconate is used for treatment of renal transplant recipients, we advise extreme caution with close observation and combination therapy to be considered instead.

Topics: Adult; Allopurinol; Antimony Sodium Gluconate; Drug Therapy, Combination; Female; Humans; Ketoconazole; Kidney Transplantation; Leishmaniasis, Visceral; Pancreatitis

We report the occurrence of two side effects, pancreatitis and palindromic arthropathy with effusions, associated with injections of sodium stibogluconate used in the treatment of kala-azar. No clear mechanism to account for the problems was identified despite extensive investigation. We suggest that when abdominal pain is experienced during treatment with antimonial drugs pancreatitis should be borne in mind as a possible cause.

Topics: Adult; Animals; Antimony Sodium Gluconate; Cyclosporins; Gluconates; Humans; Immune Tolerance; Joint Diseases; Leishmania donovani; Leishmaniasis, Visceral; Male; Malta; Pancreatitis