Annals of Tropical Medicine & Parasitology, Vol. 92, No. 2, 151±158 (1998) Treatment of visceral leishmaniasis with sodium stibogluconate in Sudan: management of those who do not respond BY E. A. G. KHALIL*, A. M. EL HASSAN, E. E. ZIJLSTRA, F. A. HASHIM Institute of Endemic Diseases, University of Khartoum, P.O. Box 45235, Khartoum, Sudan M. E. IBRAHIM Molecular Parasitology Unit, National Health Laboratory, Khartoum, Sudan H. W. GHALIB Institute of Endemic Diseases, University of Khartoum, P.O. Box 45235, Khartoum, Sudan AND M. S. ALI Faculty of Medicine, University of Khartoum, Khartoum, Sudan Received 12 August 1997, Revised 26 November 1997, Accepted 28 November 1997 Almost all (98%) of 1593 visceral leishmaniasis (VL) patients treated with sodium stibogluconate (Pentostam Ò ; Wellcome) in Sudan between 1989 and 1995 and followed-up responded well to treatment. However, the other 33 patients, all of whom were seronegative for HIV, showed partial or no response. The two main causes of unresponsiveness were primary drug resistance (39.3%) and low drug dosages given at peripheral dispensaries (30.3%). All of those who had been sub-optimal doses were cured when adequate doses of the drug were given. A third cause was concurrent disease, particularly pulmonary tuberculosis (18%). With treatment of the concurrent disease, patients responded well to Pentostam. Eight patients who failed to respond to repeated courses of Pentostam did not bene®t from pentamidine or sterol inhibitors. Three of these patients responded to liposomal amphotericin B, two responded to splenectomy in association with Pentostam therapy, and three died. Pentostam, given in adequate doses, still appears to be the drug of choice for the treatment of VL in the Sudan. Liposomal amphotericin B is a suitable second-line drug. Sodium stibogluconate (Pentostam Ò , Well- come) has been the mainstay in the treatment of visceral leishmaniasis (VL) in Sudan since it was ®rst introduced in the country, ®ve decades ago, by Kirk and Satti (1947). Various dose regimens of the drug have been investi- gated extensively (Anabwani et al ., 1983; Chu- lay et al., 1983; G. S. Gachihi, J. B. O. Were, R. K. Muigai, J. Sherwood, Z. J. Mbugua & G. Kirigi, unpubl. obs.). Zijlstra et al . (1993) recently compared three regimens (of 10 or 20 mg/kg daily for 30 days or 20 mg/kg daily for 15 days) for the treatment of VL in Sudan. As recommended by Herwaldt and Berman (1992), no limiting maximum daily dose was employed. As a result of increasingly frequent reports of antimony-resistant VL, particularly from India (Thakur et al ., 1988, 1991), the World Health Organization recommended a daily dose of 20 mg sodium stibogluconate/kg for at least 20 days for the treatment of VL (WHO, 1990). Emergence of antimony-resistant strains of Leishmania has also prompted clini- cians and researchers to use alternative drugs, that have different modes of action, to attain * E-mail: eltahir@usa.net. 0003-4983/98/020151-08 $9.00 Ó1998 Liverpool School of Tropical Medicine Carfax Publishing Ltd