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Drug combinations for visceral leishmaniasis
1UNICEF/UNPD/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland. olliarop@who.int
Current Opinion in Infectious Diseases
|September 28, 2010
Summary
Combination therapies for visceral leishmaniasis show high efficacy in India. Further research is needed in other regions to assess the benefits of these drug combinations.
Area of Science:
- Tropical medicine
- Infectious diseases
- Pharmacology
Background:
- Visceral leishmaniasis (VL) treatment has historically faced challenges with drug efficacy.
- Recent advancements have led to the development of effective drugs for VL.
- Systematic testing of drug combinations for VL is a recent development.
Purpose of the Study:
- To review the efficacy and benefits of drug combinations for treating visceral leishmaniasis.
- To assess the current status and future prospects of combination therapies in different endemic regions.
Main Methods:
- Review of recent studies on drug combinations for visceral leishmaniasis.
- Analysis of treatment outcomes, including efficacy and cost-effectiveness.
- Geographical comparison of treatment strategies and research progress.
Main Results:
- Sequential treatments (liposomal amphotericin B followed by miltefosine or paromomycin) and concomitant miltefosine/paromomycin are highly effective (>95%) in India.
- Sodium stibogluconate plus paromomycin (17 days) shows >90% efficacy in East Africa.
- Shortened combination regimens are cost-effective in India; no studies or cost-effectiveness analyses exist for Brazil, Nepal, or Bangladesh.
Conclusions:
- Sequential and co-administration treatments demonstrate high efficacy and benefits in India.
- Further studies are necessary in other endemic areas to validate these combination therapies.
- Challenges exist in introducing and scaling up these treatments, but experience from malaria control may be beneficial.
- Monitoring of efficacy and safety is crucial, and fixed-dose combination treatments are not yet available for leishmaniasis.
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