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ELECTROCARDIOGRAPHIC J?lNDINGS IN ETHIOPIANS OPi PENTAVALENT ANTIMONY THERAPY FOR VISCERAL LEISHMANIASIS
Abstract
Background: The old short course regimens of pentavalent antimonial (sbV) therapy of
visceral leishmaniasis (VL) have largely been abandoned worldwide as they are associated
with increasing problems of relapse and unresponsiveness. In Ethiopia, some hospitals still
use the dd interrupted and short course regimen partly because of fear of drug toxicity.
Objective: To evaluate the safety of the WHO recommended UI interrupted therapy at a dose
of 20 mg sbv/kg for up to thirty days.
Design: A prospective study.
Setting: Patients were recruited from Addis Ababa hospitals and from Konso VL endemic
area in southern Ethiopia.
Subjects: Forty nine patients who included, ten HN-positi~ e and 39 HIV-negative, were
enrolled for the study.
Results: Twenty three HIV-negative patients got treatment for 20 days and the rest, 16 HIVnegative
and 10 HN-positive, were treated for 28 to 30 days. 1 Lmong HN-seronegatives, the
mean QT interval corrected for heart rate (QTc) at the end of therapy in patients treated for
20 days and 28 - 30 days was comparable (0.419 k0.031 seconc Ls versus 0.424 k0.027 seconds,
respectively). Among patients treated for 28 - 30 days, the mean QTc in HIV co-infected
patients was comparable to that of HIV-negatives (0.416 A 0.018 seconds versus 0.424 +
0.027). Comparable rates of new ECG changes involving the T waves were observed in two
HIV-positive (20%) and two HIV-negative (12.5%) patients treated for 28 - 30 days, and in
seven (30.4%) HIV-negative patients treated for 20 days. 0 1 e d , only two (4.1 %) patients
(all HIV-negative males) had QTc interval s.50 seconds at th e end of therapy. In one patient,
the prolonged QTc was noted on the twentieth day with brs dycardia of 44Jminute.
Conclusions: In Ethiopian VL patients with normal renal fun:tion, sbVtherapy at a M y dose
of 20 mg /kg for up to 30 days is safe and only rarely assoc ~ated with clinically significant
bradycardia which resolves after temporary cessation of t merapy. Furthermore, in areas
with limited facilities, monitoring the pulse rate during anti~nonial therapy may help detect
impending cardiotoxicity.
visceral leishmaniasis (VL) have largely been abandoned worldwide as they are associated
with increasing problems of relapse and unresponsiveness. In Ethiopia, some hospitals still
use the dd interrupted and short course regimen partly because of fear of drug toxicity.
Objective: To evaluate the safety of the WHO recommended UI interrupted therapy at a dose
of 20 mg sbv/kg for up to thirty days.
Design: A prospective study.
Setting: Patients were recruited from Addis Ababa hospitals and from Konso VL endemic
area in southern Ethiopia.
Subjects: Forty nine patients who included, ten HN-positi~ e and 39 HIV-negative, were
enrolled for the study.
Results: Twenty three HIV-negative patients got treatment for 20 days and the rest, 16 HIVnegative
and 10 HN-positive, were treated for 28 to 30 days. 1 Lmong HN-seronegatives, the
mean QT interval corrected for heart rate (QTc) at the end of therapy in patients treated for
20 days and 28 - 30 days was comparable (0.419 k0.031 seconc Ls versus 0.424 k0.027 seconds,
respectively). Among patients treated for 28 - 30 days, the mean QTc in HIV co-infected
patients was comparable to that of HIV-negatives (0.416 A 0.018 seconds versus 0.424 +
0.027). Comparable rates of new ECG changes involving the T waves were observed in two
HIV-positive (20%) and two HIV-negative (12.5%) patients treated for 28 - 30 days, and in
seven (30.4%) HIV-negative patients treated for 20 days. 0 1 e d , only two (4.1 %) patients
(all HIV-negative males) had QTc interval s.50 seconds at th e end of therapy. In one patient,
the prolonged QTc was noted on the twentieth day with brs dycardia of 44Jminute.
Conclusions: In Ethiopian VL patients with normal renal fun:tion, sbVtherapy at a M y dose
of 20 mg /kg for up to 30 days is safe and only rarely assoc ~ated with clinically significant
bradycardia which resolves after temporary cessation of t merapy. Furthermore, in areas
with limited facilities, monitoring the pulse rate during anti~nonial therapy may help detect
impending cardiotoxicity.
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