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Drug resistance in leishmaniasis
Jaya Chakravarty1, Shyam Sundar
1Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, India.
Journal of Global Infectious Diseases
|July 8, 2010
Summary
Limited treatment options for leishmaniasis are challenged by rising drug resistance. Monitoring drug use and exploring combination therapies are crucial to combat resistance in visceral leishmaniasis (VL).
Area of Science:
- Medical Parasitology
- Infectious Diseases
- Drug Resistance Studies
Background:
- Leishmaniasis treatment relies heavily on pentavalent antimonials (Sb(v)), with limited alternatives.
- Widespread misuse has driven the emergence of Sb(v) resistance, particularly in North Bihar.
- Drug resistance is a growing concern, exacerbated by factors like anthroponotic transmission and HIV/visceral leishmaniasis (VL) coinfection.
Purpose of the Study:
- To highlight the critical issue of drug resistance in leishmaniasis treatment.
- To emphasize the need for effective monitoring of drug use and patient response.
- To advocate for the consideration of combination therapy regimens to mitigate resistance.
Main Methods:
- Discussion of current treatment limitations and resistance mechanisms.
- Identification of patient populations at higher risk for resistance development (e.g., HIV/VL coinfected).
- Mention of the in vitro amastigote-macrophage model as the current standard for resistance monitoring.
Main Results:
- Pentavalent antimonials (Sb(v)) face significant resistance due to misuse.
- No reliable molecular markers for leishmaniasis drug resistance are currently available.
- The in vitro amastigote-macrophage model is technically demanding for resistance monitoring.
Conclusions:
- The limited drug arsenal for leishmaniasis necessitates stringent monitoring of drug efficacy.
- Preventing the spread of drug resistance is paramount for effective leishmaniasis control.
- Simultaneous or sequential combination therapies should be seriously considered to preserve drug effectiveness.
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