Inefficacy of ethambutol, ethambutol plus isoniazid, INH plus rifampicin, co-trimoxazole and metronidazole in the treatment of kala-azar

Abstract

In an attempt to find an orally effective drug against kala-azar, ethambutol alone, ethambutol plus INH, INH plus rifampicin, co-trimoxazole and metronidazole were tried in the treatment of 70 patients of Indian kala-azar. Ethambutol and ethambutol plus INH were totally ineffective. INH and rifampicin were tried in 10 cases; in three there was some clinical improvement but all relapsed and were cured with sodium stibogluconate. Co-trimoxazole reduced fever in four out of 20 cases, but all relapsed within 2 months. In one case the general health was well maintained but the splenic aspirate contained a large number of parasites and there was no regression in the size of the spleen. The patient was ultimately cured with sodium stibogluconate. Metronidazole orally or intravenously was not effective. It is suggested that, as these drugs are ineffective, a search for an oral substitute to sodium stibogluconate should continue.