Current and emerging pharmacological treatments for visceral leishmaniasis

Visceral leishmaniasis (VL) remains one of the most challenging parasitic diseases globally, with significant morbidity and mortality rates, particularly in endemic regions. First-line treatment regimens such as monochemotherapy with pentavalent antimonials, miltefosine, and amphotericin B are often hindered by toxicity, high cost, and the emergence of drug resistance. Recent advances in pharmacological interventions have expanded the therapeutic landscape to include synergistic drug combinations, novel synthetic compounds, and bioactive natural alternatives. This review critically examines the current pharmacological strategies for VL, emphasizing monochemotherapy, synergistic drug combinations, and the potential of novel chemical synthesis and natural products. The limitations of existing treatments, including adverse effects and drug resistance, are discussed, alongside emerging trends in drug development. By integrating these diverse therapeutic strategies, this review aims to provide a comprehensive understanding of current and emerging treatments for VL, highlighting the need for continued innovation to combat drug resistance and improve patient outcomes.