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JAC Advance Access originally published online on August 17, 2006
Journal of Antimicrobial Chemotherapy 2006 58(4):811-815; doi:10.1093/jac/dkl342
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A comparison of liposomal amphotericin B with sodium stibogluconate for the treatment of visceral leishmaniasis in pregnancy in Sudan

Marius Mueller1, Manica Balasegaram1,*, Youssif Koummuki1, Koert Ritmeijer1, Muriel Ramirez Santana1 and Robert Davidson1,2

1 Médecins sans Frontières, 67-74 Saffron Hill London EC1N 8QX, UK 2 Department of Infection Tropical Medicine, Lister Unit, Northwick Park Hospital, Harrow Middlesex HA1 3UJ, UK

Received 31 October 2005; returned 27 March 2006; revised 4 May 2006; accepted 29 July 2006

*Corresponding author. Tel: +44-20-7067-4235; Fax: +44-20-7404-4466; E-mail: manica.balasegaram{at}london.msf.org

Objectives: Little is known about the treatment of visceral leishmaniasis (VL) in pregnancy, especially in resource-poor settings. We present a series of pregnant women with VL treated with either sodium stibogluconate or liposomal amphotericin B (AmBisome), or both, in eastern Sudan over 16 months.

Methods: We did a retrospective analysis of all pregnant VL patients treated in the Médecins sans Frontières (MSF) Um el Kher centre between January 2004 and April 2005. We diagnosed VL with laboratory confirmation of clinical suspects, and recorded the outcomes of treatment for pregnant women and their foetuses. We carried out a manual search of relevant publications and a systematic search of the literature in the MEDLINE database.

Results: We treated 23 women with sodium stibogluconate, 4 with AmBisome and sodium stibogluconate and 12 with AmBisome alone. There were 13 (57%) spontaneous abortions in the sodium stibogluconate monotherapy group, and none in either of the other two groups. All spontaneous abortions occurred in the first two trimesters. All patients, except one in the sodium stibogluconate group who defaulted, were discharged as cured in good clinical condition.

Conclusions: AmBisome treatment for VL appears to be safe and effective for pregnant women and their foetuses. We recommend the use of AmBisome as first-line treatment for these patients.

Keywords: kala-azar , neglected disease , AmBisome


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