Post kala-azar dermal leishmaniasis (PKDL) is a skin disorder that usually occurs among patients with a past history of visceral leishmaniasis (VL).Cases are also reported without a history of VL.There is no satisfactory treatment regimen available at present.
We aimed to compare the efficacy and safety of amphotericin B in two different doses (0.5mg/kg vs 1mg/kg) in a prospective randomized trial in 50 PKDL patients.In this open label study 50 patients with PKDL, aged between 5-60 years were randomized in two groups.
Group A received amphotericin B in the dose of 0.5 mg/kg in 5% dextrose, daily for 20 infusions for 3 courses Outdoor Decor at an interval of 15 days between each course and Group B received amphotericin B in the dose of 1mg/kg in 5% dextrose on alternate days, 20 infusions for 3 courses an interval of 15 days between each course and followed up for one year.A total of 50 patients were enrolled, 25 in each of group A and group B.
Two patients lost to follow up and three patients withdrew consent due to adverse events.The initial cure rate was 92% in group A and 88% in group B by intention to treat analysis and final cure rate by per protocol analysis was 95.65% and 95.
45% in group A and Multi Charm Wooden Keychain group B respectively.Two patients each from either group relapsed.Nephrotoxicity was the most common adverse event occurring in both the groups.
The lower dose appears to have fewer adverse events however, nephrotoxicity remains a problem in both regimens.The 0.5mg/kg regimen may be considered instead of the higher dosage however safer treatments remain critical for PKDL treatment.