Drug combinations for visceral leishmaniasis.

Abstract:

PURPOSE OF REVIEW:Several attempts have been made to combine drugs for treating visceral leishmaniasis, but only recently have effective drugs become available and combinations been tested systematically. RECENT FINDINGS:Sequential treatments with liposomal amphotericin B followed by miltefosine or paromomycin (as short as 7 days), as well as the concomitant administration of miltefosine and paromomycin (for 10 days) are very effective in India (>95%). Sodium stibogluconate plus paromomycin for 17 days is more than 90% effective in East Africa. The shortened combination regimens are cost-effective in India. No combination has been tested so far in Brazil, Nepal and Bangladesh, although studies may be expected in the near future. No cost-effectiveness analysis has been done as yet outside India. SUMMARY:There is evidence of high efficacy and benefits with sequential and co-administration treatments in India. More studies are needed in other endemic areas. Introducing combinations and scaling up their use will be challenging. Experience acquired with malaria may be useful. Proper monitoring of use and effects (efficacy and safety) will be required. Currently there are no options for fixed-dose combination treatments for leishmaniasis.

journal_name

Curr Opin Infect Dis

authors

Olliaro PL

doi

10.1097/QCO.0b013e32833fca9d

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

595-602

issue

6

eissn

0951-7375

issn

1473-6527

journal_volume

23

pub_type

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