The treatment of visceral leishmaniasis (kala-azar) in India: no obvious signs of long-term success.

In India, the eastern state of Bihar is particularly badly affected by visceral leishmaniasis (VL). It was in Bihar in the 1980s that the first clear signs of resistance to pentavalent antimonials, which had then been the standard antileishmanial treatment for several decades, were observed. New drugs and new formulations of old drugs have since been developed for the treatment of VL. However, despite some initial signs of benefit after each major revision in the method of treatment of VL in India, the VL-related case fatality rates recorded in India since the 1970s show no clear evidence of long-term success. In fact, the most recent data indicate that such rates have stabilised or even increased, probably because of the continued usage of sodium stibogluconate in northern Bihar.