Use of amphotericin B in drug-resistant cases of visceral leishmaniasis in north Bihar, India.

Thirty-four multidrug-resistant cases of Indian visceral leishmaniasis (kala-azar) were treated with amphotericin B. A complete hemogram, liver and renal function tests, determination of serum electrolyte levels, a chest radiograph, and an electrocardiogram were done before, during, and after completion of therapy. Assessment for clinical and parasitologic cure was done weekly. Thirty-one patients who completed treatment had full cure after receiving 10-15 injections at six-months follow up. One patient died of myocarditis. A febrile reaction was observed in all cases, while thrombophlebitis was found in six cases (18.75%). Anorexia, nausea, and vomiting were found in seven cases (21.88%). No significant nephrotoxicity or electrolyte disturbances were observed. It is concluded that amphotericin B is an effective second-line drug for Indian visceral leishmaniasis, but unpredictable drug-induced myocarditis remains a problem.