E. Erduran
Jan 1, 2006
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Journal
Pediatric Hematology and Oncology
Abstract
I read with a great interest the interpretation by Dr. Ozsoylu about our manuscript. He stated that stibosamine (Neostibosan) or meglumine antimonate (MA) in the dose of 20 mg/kg/d for 3 days, 30 mg/kg/d for 3 days, and 60 mg/kg/d for 2 weeks or the combination of MA followed by pentamidine isethionate in the dose of 2.5 mg/kg every other day for a total 15 doses has been successfully used in the treatment of visceral leishmaniasis (VL) and this treatment procedure is cheaper than liposomal amphotericin B (LAmB) treatment in addition to the expensive treatments should be saved for resistant cases to conventional treatment. Pentavalent antimony (PA) has been used as the first-line drug in the treatment of VL for a long time [1, 2]. Recently, PA therapy of VL has been abandoned worldwide because the patients do not always respond to the treatment and the drug has toxic effects [3, 4]. Extensive research has been done about resistance of the drugs using in the treatment of VL in the North Bihar, an endemic region of India. Resistance rates of the treatment of VL with sodium antimony gluconate (Sb) were found to increase from 1981 to 1997 (30 and 64%, respectively) and the addition of IFN-γ improved the cure rates to 42 and 49%, depending on the increased doses of IFN-γ [5, 6]. Jha [7] suggested that pentamidine should be used as a first-line drug in patients refractory to Sb, and high cure rates were seen. But its efficacy has declined over the years and now it cures approximately 70% of patients with VL [8]. Clinical unresponsiveness could be overcome by increasing the dose or duration of therapy. However, serious and fatal toxicity associated with the current regimen are at the limits of accessibility and increasing the dose of Sb any further would seriously jeopardize the safety of the patients. Sb is no longer used as the first-line drug in areas with high resistance. Pentamidine and LAmB are the two alternative antileishmanial drugs. Pentamidine is unsuitable for use as a first-line therapy of VL because of its serious toxicities [9]. Das et al. [10] used sodium stibogluconate