Clinicoepidemiological study of drug resistance in Indian kala - azar

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Abstract
We studied 312 patients with Indian kala-azar (proved parasitologically) who had received one or more courses of antimony but had failed to recover. The mean weight of these patients was 38.8 (SD 13.3) kg; 169 patients weighed more than 42.5 kg. Only 81 patients had received adequate antimony treatment, according to the WHO's guidelines, before being considered to have refractory disease. Two hundred and twenty seven patients had consulted an unqualified practitioner initially, and 87 of these had consulted one again during their first relapse. Most patients (225) received the drug for less than 40 days; 87 received it for less than 20 days and 147 for less than 30 days. One hundred and thirty two patients did not take it regularly, and 112 stopped taking the drug on their own initiative. Most of them (310) used their own resources to buy the drug. As a consequence of treatment 12 patients developed cellulitis and 13 developed abscesses at the site of injection. The table gives the details of the drug treatment given to patients during their first and second relapses. To our surprise 70 of the 149 patients who received pentamidine during their first relapse had not received adequate antimony treatment.