Two new drugs have been introduced in India at the initiative of multilateral agencies, but while they have some advantages, there are issues with both of them, not least of all drug resistance.

The WHO gives the highest therapeutic index of existing drugs for kala azar to liposomal amphotericin B. Not only is it the safest and most effective drug for kala azar, it is a ten-day treatment. The problem is that it is very expensive. At retail price in India, treatment would cost Rs 1.5 to 3 lakh at US$ 280 per vial. The manufacturer offers the price of US$20 per vial for public sector agencies of developing countries. But even with the preferential price, it remains unaffordable for most patients.

And so, there is a quest to find a short course cure that is safe and effective. There is much research being done in labs inside and outside India, funded by international donor agencies and by the government of India. There are even combination therapy trials underway to overcome the shortfalls of the current drugs available in India for kala azar.

An amphotericin B emulsion, researched, developed and internationally patented by an Indian company, has been in the market since 2003. Recent studies have shown that it achieved a 100 per cent cure rate with a single dose of the medication. Studies also show it is at least as effective and safe as the liposomal amphotericin B. Priced at half the concessional rate of liposomal amphotericin B, it is affordable. So it appears that we have a promising cure for kala azar that is effective, safe, affordable, and which can even be an out-patient treatment.

... contd.