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JAC Advance Access published online on May 18, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh279
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received November 15, 2003
Revised January 24, 2004
Accepted April 13, 2004

Original article

A 6 day course of liposomal amphotericin B in the treatment of infantile visceral leishmaniasis: the Italian experience

Antonio Cascio 1*, Lucio di Martino 2, Paolo Occorsio 2, Raffaella Giacchino 3, Salvatore Catania 4, Anna Rita Gigliotti 3, Camilla Aiassa 4, Chiara Iaria 5, Salvatore Giordano 6, Claudia Colomba 6, Valentina Frasca Polara 6, Lucina Titone 6, Luigi Gradoni 7, Marina Gramiccia 7, Spinello Antinori 8

1 Clinica Malattie Infettive, Università di Messina, Messina, Italy; AILMI (Associazione Italiana per la Lotta contro le Malattie Infettive) ONLUS, Messina, Italy
2 U.O. di Pediatria Infettivologica, A.O. Santobono-Pausilipon, Napoli, Italy
3 Unità Operativa di Malattie Infettive, Istituto G. Gaslini, Genova, Italy
4 Dipartimento Malattie Infettive, Policlinico Umberto I, Università La Sapienza Roma, Rome, Italy
5 Clinica Malattie Infettive, Università di Messina, Messina, Italy; AILMI (Associazione Italiana per la Lotta contro le Malattie Infettive) ONLUS, Messina, Italy
6 Istituto di Patologia Infettiva e Virologia, Università di Palermo, Palermo, Italy
7 Laboratorio di Parassitologia, Istituto Superiore di Sanità, Rome, Italy
8 Istituto di Malattie Infettive e Tropicali, Università di Milano, Milan, Italy

* To whom correspondence should be addressed. E-mail: acascio{at}unime.it.


  Abstract

Objectives: To evaluate in a retrospective analysis the efficacy and safety of a 6 day course of liposomal amphotericin B (L-AmB) in infantile cases of Mediterranean visceral leishmaniasis (VL) diagnosed over a 10 year period in Italy.

Patients and methods: Patients included were diagnosed as having VL consecutively admitted from December 1992 to December 2001 at four main referral children's hospitals in Italy and treated with six intravenous doses of 3 mg/kg L-AmB given on days 1-5 and 10 (a total dose of 18 mg/kg). Demographic data, nutritional status, underlying diseases, clinical and laboratory findings, and therapy outcome were considered.

Results: A total of 164 HIV-negative children (median age 1.6 years; range 4 months to 14 years) were enrolled. All patients were initially cured by the given treatment, and did not present adverse events related to drug infusion. Seven patients (4.3%) had a clinical and parasitological relapse 3-15 months after therapy. All relapses were successfully retreated with 3 mg/kg L-AmB for 10 consecutive days (a total dose of 30 mg/kg).

Conclusions: This study highlights the efficacy (>95%) and safety of the six dose L-AmB regimen and validates it as a first-line treatment for Mediterranean VL in children.

Key Words: Keywords: Leishmania infantum, Italy, therapy


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