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Amphotericin B therapy in children with visceral leishmaniasis: daily vs. alternate day, a randomized trial

Utpal Kant Singh1, Rajniti Prasad, Bir Prakash Jaiswal

  • 1Department of Pediatrics and Child Care Center, Nalanda Medical College, Patna 800016, Bihar, India. utpalkant.singh@yahoo.co.in

Journal of Tropical Pediatrics
|January 13, 2010
PubMed

Insights

Daily amphotericin B is as effective and safe as alternate-day dosing for treating childhood visceral leishmaniasis (VL). This daily regimen offers a more cost-effective treatment option with shorter hospital stays for VL patients.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Pharmacology

Background:

  • Visceral leishmaniasis (VL) is a serious parasitic disease affecting children.
  • Current treatment guidelines often recommend alternate-day amphotericin B regimens.
  • Optimizing amphotericin B administration is crucial for improving patient outcomes and reducing healthcare costs.

Purpose of the Study:

  • To compare the efficacy and safety of daily versus alternate-day amphotericin B in pediatric visceral leishmaniasis.
  • To evaluate treatment costs and duration of hospital stay associated with different amphotericin B dosing schedules.
  • To determine the optimal dosing strategy for amphotericin B in children with VL.

Main Methods:

  • A randomized controlled trial involving 605 children under 14 years with VL.
  • Group A received amphotericin B (1 mg/kg/day) daily for 15 days.
  • Group B received the same dose on alternate days.

Main Results:

  • All patients completing therapy in both groups achieved a cure.
  • No relapses were observed at 1 and 6 months post-treatment.
  • Adverse reactions were not significantly different between the daily and alternate-day groups.
  • Daily dosing led to significantly shorter hospital stays and lower therapy costs.
  • Higher rates of patients leaving against medical advice were noted in the alternate-day group.

Conclusions:

  • Daily amphotericin B is an equally effective and well-tolerated treatment for pediatric visceral leishmaniasis compared to alternate-day dosing.
  • The daily regimen is more cost-effective and associated with reduced hospital stays.
  • Daily administration of amphotericin B is a viable and potentially superior alternative to the current alternate-day practice for VL treatment in children.

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