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Related Experiment Videos

Visceral leishmaniasis - current therapeutic modalities.

Shyam Sundar1, Mitali Chatterjee

  • 1Kala-azar Medical Research Center, Department of Medicine, Institute of Medical Sciences Banaras Hindu University, Varanasi, India. shyam_vns@satyam.net.in

The Indian Journal of Medical Research
|June 17, 2006
PubMed
Summary

Visceral leishmaniasis (VL) treatment faces challenges like drug resistance and toxicity. New drugs like paromomycin show promise for affordable and effective chemotherapy against this parasitic disease.

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Area of Science:

  • Tropical Medicine and Infectious Diseases
  • Parasitology
  • Pharmacology

Background:

  • Visceral leishmaniasis (VL) treatment is hampered by increasing antimonial drug resistance, particularly in Bihar, India, and relapses in HIV-Leishmania co-infected individuals.
  • Current VL therapies exhibit limitations including toxicity, parenteral administration, and prolonged treatment durations, necessitating exploration of alternative treatment strategies.
  • Existing drugs like pentavalent antimony are being replaced by amphotericin B deoxycholate in refractory zones, but its application is limited by hospitalization needs and toxicity.

Purpose of the Study:

  • To review advancements in visceral leishmaniasis (VL) treatment, focusing on overcoming therapeutic obstacles.
  • To highlight the mechanisms of action of various antileishmanial drugs.
  • To guide researchers in developing affordable and effective chemotherapy for VL.

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Main Methods:

  • Review of existing literature on visceral leishmaniasis (VL) treatment modalities.
  • Analysis of drug efficacy, toxicity, administration routes, and cost-effectiveness.
  • Evaluation of emerging and established antileishmanial agents, including miltefosine, amphotericin B formulations, paromomycin, azoles, allopurinol, and sitamaquine.

Main Results:

  • Miltefosine is the first orally effective drug approved for VL treatment.
  • Liposomal amphotericin B offers high cure rates (>90%) with reduced toxicity but is cost-prohibitive for widespread use in endemic regions.
  • Paromomycin shows encouraging preliminary results and may become a cost-effective antileishmanial drug; other oral agents like azoles and allopurinol have had limited success due to efficacy or toxicity issues.

Conclusions:

  • Significant progress has been made in VL treatment, yet challenges of drug resistance, toxicity, and cost persist.
  • Liposomal amphotericin B and paromomycin represent key developments, with the latter offering potential affordability.
  • Further research and development are crucial for discovering and implementing accessible, effective chemotherapy options for visceral leishmaniasis.