[Treatment of visceral leishmaniasis]

Aim of this report is to review the most important therapeutical choices in visceral leishmaniasis. The pentavalent antimonial derivatives (PAD) remain the first-line drugs despite the toxicity and the wide resistance. Among the other therapeutical options, the importance of lipid formulations of amphotericin B is emphasized; it is a valid resource for the treatment of leishmania-HIV co-infection in the European Mediterranean Countries; instead, due to the high cost, it cannot be proposed in developing Countries. Besides, the characteristics of other drugs are evaluated: pentamidine, aminosidine, miltefosine, allopurinol, ketoconazole, gamma-interferon; such options propose different validity in different geographical regions. Among these, interesting results are reported for miltefosine, both for efficacy and practicality of use. Finally, the importance of a vaccination strategy in endemic areas of developing Countries is underlined.