Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 19 November 2017

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Oral miltefosine for Indian visceral leishmaniasis

Oral miltefosine is an effective and safe treatment for Indian visceral leishmaniasis, find researchers in the latest issue of the New England Journal of Medicine.

News image

fiogf49gjkf04

There are approximately 500,000 cases per year of visceral leishmaniasis.

These occur primarily in the Indian subcontinent.

Almost all untreated patients die, and all the effective treatment agents are parenteral.

However, miltefosine is an oral agent that has a favorable therapeutic index for Indian visceral leishmaniasis, in small numbers of patients

6 months later, 94% of the miltefosine group and 97% of the amphotericin B group had not relapsed.
New England Journal of Medicine

In this study, a team of international researchers performed a clinical trial in India, comparing miltefosine with the most effective standard treatment, amphotericin B.

The team orally administered miltefosine (50 or 100 mg [approximately 2.5 mg per kilogram of body weight] daily for 28 days) to 299 patients, 12 years or older.

In addition, 99 patients received intravenously administered amphotericin B (1 mg per kilogram, every other day for a total of 15 injections).

The groups were well matched in terms of age, weight, proportion with previous failure of treatment for leishmaniasis, parasitologic grade of splenic aspirate, and splenomegaly.

At the end of treatment, the researchers obtained splenic aspirates from 293 patients in the miltefosine group, and from 98 patients in the amphotericin B group.

The team did not identify any parasites, and determined and an initial cure rate of 100%.

By 6 months after the completion of treatment, 94% of patients in the miltefosine group and 97% of patients in the amphotericin B group had not had a relapse. The researchers classified these patients as cured.

However, a greater number of patients in the miltefosine group experienced vomiting (38%) and diarrhea (20%), lasting 1 to 2 days.

Dr Shyam Sundar's team concluded, "Oral miltefosine is an effective and safe treatment for Indian visceral leishmaniasis".

"Miltefosine may be particularly advantageous because it can be administered orally."

"It may also be helpful in regions where parasites are resistant to current agents."

In related editorial in the same publication, Dr Henry Murray also discusses visceral leishmaniasis, or kala-azar, and its prevalence in India, Nepal, Bangladesh, Brazil, and Sudan.

Dr Murray concludes that visceral leishmaniasis "remains a neglected disease".

"The biggest problem today is no longer a lack of basic research, epidemiological work, or clinical investigation into diagnosis and treatment."

"Instead the real obstacle now…is proper translation, distribution, and expansion of the advances that have been made."

N Engl J Med 2002; 347(22): 1739-46. 1793-4
02 December 2002

Go to top of page Email this page Email this page to a colleague

 17 November 2017 
Food elimination diets for treatment of adults with eosinophilic esophagitis
 17 November 2017 
PPI use and cognitive function in women
 17 November 2017 
Predicting microscopic colitis
 16 November 2017 
NAFLD-hepatocellular carcinoma and survival after orthotopic liver transplant
 16 November 2017 
Prepregnancy obesity and severe maternal morbidity
 16 November 2017 
Celiac disease screening in adult first-degree relatives
 15 November 2017 
Breastfeeding and the risk of IBD
 15 November 2017 
Medication nonadherence and health care costs
 15 November 2017 
Predicting recurrence after curative rectal cancer surgery
 14 November 2017 
HBV/HCV coinfection and cirrhosis
 14 November 2017 
Sexual dysfunction after rectal cancer surgery
 14 November 2017 
Eosinophilic gastroenteritis and colitis
 13 November 2017 
GI bleeding in patients taking non–vitamin K antagonist oral anticoagulants
 13 November 2017 
Genetic polymorphisms, fatty acids and ulcerative colitis
 13 November 2017 
Flares after immunomodulator withdrawal in Crohn's
 10 November 2017 
Thiopurines vs TNF and lymphoma risk in IBD
 10 November 2017 
Drug monitoring of anti-tumour necrosis factor therapy in IBD
 10 November 2017 
Treatment decisions for older patients with colorectal cancer
 09 November 2017 
Quality standards in upper gastrointestinal endoscopy
 09 November 2017 
Irradiated rectal cancer and chemoradiotherapy
 09 November 2017 
Environmental factors and IBD
 08 November 2017 
Prophylaxis of spontaneous bacterial peritonitis
 08 November 2017 
Socioeconomic characteristics in diverticular disease
 08 November 2017 
Optimal management of postoperative Crohn's disease
 07 November 2017 
Community Screening for Helicobacter pylori
 07 November 2017 
Early readmission in IBD patients
 07 November 2017 
Mesocolic excision for colon cancer
 06 November 2017 
Food elimination diet for children with eosinophilic esophagitis
 06 November 2017 
Biologic agents and obesity in children with IBD
 06 November 2017 
Liver cancer burden despite extensive use of antiviral agents
 03 November 2017 
Statins and mortality in chronic viral hepatitis
 03 November 2017 
Propofol for outpatient colonoscopy
 03 November 2017 
Asthma and IBD development
 02 November 2017 
Diverticulitis and emergency department burden
 02 November 2017 
Rural residence and risk of IBD
 02 November 2017 
Sexual functioning in Hep C
 01 November 2017 
Heartburn relief in adolescents with GERD
 01 November 2017 
Barriers to hepatitis C treatment
 01 November 2017 
Autoimmune pancreatitis in children
 31 October 2017 
Surveillance in ulcerative colitis and Crohn’s disease
 31 October 2017 
Endoscopic indices of disease activity for Crohn’s
 31 October 2017 
Follow-up of positive results on fecal blood tests
 30 October 2017 
Local recurrence after curative rectal cancer surgery
 30 October 2017 
Low-flow ascites pump in refractory cirrhosis
 30 October 2017 
Medical therapy of patients with pediatric-onset IBD
 27 October 2017 
NAFLD in advanced fibrosis in the USA
 27 October 2017 
Early readmission in cirrhosis after bacterial infections
 26 October 2017 
Predicting response to anti-TNF therapy in Crohn's
 26 October 2017 
Conversion to open laparotomy in rectal cancer
 25 October 2017 
Conversion of colonoscopy to sigmoidoscopy
 25 October 2017 
Fecal microbiota transplantation
 25 October 2017 
Rifaximin and survival in hepatic encephalopathy
 24 October 2017 
Eosinophilic esophagitis with swallowed topical corticosteroids
 24 October 2017 
Meta-analysis in nutritiona research
 23 October 2017 
NAFLD-related hepatocellular carcinoma in liver resection
 23 October 2017 
Outcome of hepatic sarcoidosis
 20 October 2017 
Hospital readmissions reduction program
 20 October 2017 
Conversion of planned colonoscopy to sigmoidoscopy
 19 October 2017 
Fecal immunochemical tests in colorectal cancer screening
 19 October 2017 
Current management of chylous ascites

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2017 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us