A retrospective study of intravenous sodium stibogluconate alone and in combinations with allopurinol, rifampicin, and an immunomodulator in the treatment of Indian post-kala-azar dermal leishmaniasis

Background and Aims: A retrospective analysis of treatment outcome using recommended dose of sodium stibogluconate (SSG) alone and in combination with other antileishmanial drugs in adults with post-kala-azar dermal leishmaniasis (PKDL) attending as outpatients.
Methods: A total of 61 patients seen over ten years were included in the report. All had polymorphic lesions. Diagnosis was based on clinical picture, hailing from kala-azar (KA) endemic area, exclusion of other dermatoses, histopathology, and therapeutic response. Patients were distributed into two groups: Group I (n = 32), where SSG was given intravenously; in Group II (n = 29), they were allocated to one of four categories using SSG in combination with other drugs. In the first category, SSG was given along with allopurinol (n = 10); in second with rifampicin (n = 6); and in third with both allopurinol and rifampicin (n = 5). In the fourth category, SSG was administered with an immunomodulator (n = 8), Mw vaccine, known to enhance host Th1 response.
Results: Only 12 out of 61 patients completed treatment till histopathologic evidence of cure, five in Group I and seven in Group II, no patient being from third category. None had taken SSG without interruptions. Time taken for papulonodules to subside was similar in both groups, but erythema and induration subsided earlier in Group II. Group I patients attained cure after 120 injections while in Group II it took 95 injections in SSG + allopurinol and Mw vaccine categories respectively, and 110 with SSG + rifampicin. Nevertheless this was insufficient to facilitate compliance. Poor performance and high dropouts related to long duration of therapy, thrombophlebitis, difficulty in accessing veins, disabling rheumatic side-effects and practical problems. Liver, renal and pancreatic functions and ECG remained normal.
Conclusion: No major advantage was obtained using allopurinol, rifampicin or Mw vaccine along with SSG as compared to SSG alone.

Keywords
Allopurinol, kala-azar, Leishmania donovani, Mw vaccine, post-kala-azar dermal leishmaniasis, rifampicin, sodium stibogluconate, visceral leishmaniasis