Download caso clinico - colegio quimico farmaceutico departamental de lima

CASO CLINICO N° 01
NOMBRE: C.V.J.R
EDAD: 43 años
SEXO: Masculino
PESO: 85 Kg
HISTORIA CLINICA: 235600
ESTABLECIMIENTO DE SALUD: Hospital Militar Central
DESCRIPCION DEL CASO
Paciente con diagnóstico de Leishmaniasis cutánea inicia tratamiento con
Estibogluconato de sodio (1.5 g) EV diario desde el 19 de Junio del 2008.
El 26 de Junio del 2008 presenta mialgias en miembros inferiores, artralgias,
fatiga, cefalea luego de recibir 8 dosis de Estibogluconato de sodio (1.5 g) EV,
completó las 13 dosis, se recupera y acude al HMC.
Antecedentes patológicos: No presenta Diabetes Mellitus tipo 2, ni hipertensión
arterial ni tuberculosis. En el 2007 se le diagnosticó hipercolesterolemia y en
1994 gastritis, niega haber presentado reacciones adversas a medicamentos
anteriormente. Consume alcohol ocasionalmente.
Al ingreso presentó Aparente regular estado general, estado de nutrición y
estado de hidratación..
Funciones Vitales: F.C: 70 F.R: 20 PA: 100/60 T°: 37
Recibe como terapia de soporte Ibuprofeno tab, diclofenaco 75 mg inyectable.
Reinicia tratamiento con Estibogluconato de sodio el 17 de julio del 2008
presentándose nuevamente el malestar antes descrito.
NOTIFICA:
NOMBRE: LAC
PROFESION: QUIMICO FARMACEUTICO
DIRECCION: HOSPITAL MILITAR CENTRAL
FECHA: 10-01-2009
Micromedex 2.0
SODIUM STIBOGLUCONATE
A) MECHANISM OF ACTION
1) Sodium stibogluconate (sodium antimony gluconate) is one of 2 pentavalent antimony
compounds used in the treatment of leishmaniasis (Balloud et al, 1987); the other compound is
meglumine antimoniate.
2) Chemically, sodium stibogluconate is of indefinite composition; it contains 30% to 34%
antimony when dried.
3) Pentavalent antimonial compounds have been used for decades in the treatment of visceral,
cutaneous, and mucocutaneous leishmaniasis. However, the precise mechanism of action of
the antimonials remains unknown. These compounds may inhibit various enzymes in
Leishmania and possibly have actions on parasite ribosomes.
4) Electron microscopy studies of Leishmania donovani in splenic aspirates of patients with
visceral leishmaniasis have suggested that sodium stibogluconate affects active transport
functions and/or the permeability of parasite membranes.
B) REVIEW ARTICLES
1) The treatment of leishmaniasis is reviewed, including use of pentavalent antimonials,
amphotericin B, paromomycin (aminosidine), pentamidine, and imidazole compounds.
Cutaneous leishmaniasis
a) A 10-day course (n=19) of sodium stibogluconate 20 milligram/kilogram/day was as
effective as a 20-day course (same dosage) (n=19) in the treatment of cutaneous
leishmaniasis in US military personnel (age range: 19-44 years) in a well-designed
study
b) Kenyan cutaneous leishmaniasis (LEISHMANIA AETHIOPICA) has been more
resistant and higher doses appear to be needed. Intravenous sodium stibogluconate in
doses of 18 to 20 milligrams of antimony/kilogram twice daily for 30 days have been
effective .
c) A 28-day or 40-day course of sodium stibogluconate (equivalent to 20 milligrams of
antimony 1 kilogram/day) achieves approximately a 63% cure rate . The generally
accepted treatment duration for cutaneous leishmaniasis is 20 days .
d) Combination sodium stibogluconate and aminosidine appear to prevent relapses for
up to 21 months. They also stated that the use of antimony compounds by themselves
resulted in relapses.
e) Higher doses may be required for patients with Leishmania tropica or Leishmania
major and/or extension of therapy to at least 30 days, with repeat courses being
administered if necessary. Doses of 20 milligrams/kilogram twice daily (every 12 hours)
or prolongation of therapy to 60 days with doses of 20 milligrams/kilogram daily have
been suggested in relapsed patients.
f) Recommended intravenous or intramuscular doses of sodium stibogluconate in
patients with American cutaneous leishmaniasis due to LEISHMANIA BRAZILIENSIS or
LEISHMANIA MEXICANA are 20 milligrams of antimony/kilogram/day (max 850
milligrams) once daily for 20 to 28 days, repeated or continued until clinical response is
evident.
Musculoskeletal Effects
Arthralgia
1) Arthralgia and MYALGIA have been described with stibogluconate patients .
Although arthralgia was reported in only 5 of 371 patients receiving 15 or 20
mg/kg/day intramuscularly for the treatment of visceral leishmaniasis in one study,
this complication appears to be relatively frequent (58% to 83%) in other reports .
Anti-inflammatory agents were effective in reducing arthralgic pain .
2) Arthralgias (58% to 60% incidence) and myalgias (50% to 55% incidence) were
the most frequently reported adverse reactions in a non- controlled U.S. military
study (n=96) of sodium stibogluconate therapy of leishmaniasis. These symptoms
were managed with exercise restrictions and nonsteroidal anti-inflammatory agents.
Only 3 cases were severe enough to necessitate interruption of treatment .
Neurologic Effects
Central nervous system finding
1) HEADACHE, LETHARGY, MALAISE, and NEURALGIAS have been reported in
patients
treated
with
parenteral
sodium
stibogluconate .
2) A reversible PERIPHERAL NEUROPATHY has been associated with SODIUM
STIBOGLUCONATE therapy in one patient being treated for cutaneous
leishmaniasis. Following 15 days of therapy with daily intravenous sodium
stibogluconate (20 milligrams/kilogram; 1,320 mg), numbness and tingling in the
extremities, lips, and tongue, were noted. Vibratory sensation was up to 30%
decreased in the ankles and fingertips, and the drug was discontinued. At a 10
week follow up visit, the majority of symptoms had resolved