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[Treatment of infantile visceral leishmaniasis]
P Minodier1, F Faraut-Gambarelli, R Piarroux
1Service de pédiatrie, CHU Nord, Marseille, France.
Insights
Visceral leishmaniasis treatment in children faces challenges with antimony due to side effects and resistance. Liposomal amphotericin B offers a more tolerable and effective alternative for this endemic disease.
Area of Science:
- Infectious Diseases
- Parasitology
- Pediatrics
Background:
- Visceral leishmaniasis is endemic in the Mediterranean Basin, primarily affecting children.
- Current treatments like pentavalent antimony have limitations including adverse events and drug resistance.
- Alternative therapies such as diamidines and amphotericin B derivatives are explored.
Purpose of the Study:
- To review current treatment options for visceral leishmaniasis in children.
- To evaluate the efficacy and safety of alternative therapies compared to standard antimony treatment.
- To highlight the advantages of liposomal amphotericin B.
Main Methods:
- Review of existing literature on visceral leishmaniasis treatments.
- Comparative analysis of drug efficacy, pharmacokinetics, and adverse event profiles.
- Assessment of resistance patterns and treatment outcomes.
Main Results:
- Pentavalent antimony is associated with frequent adverse events and resistance.
- Diamidines have poorly understood pharmacokinetics and significant adverse effects.
- Liposomal amphotericin B demonstrates enhanced efficiency, better tolerance, and shorter treatment duration (5 days) with no described primary resistance in immunocompetent children.
- Combination therapy with allopurinol and antimony showed no added benefit.
Conclusions:
- Liposomal amphotericin B is a promising alternative for pediatric visceral leishmaniasis treatment.
- Improved tolerability and efficacy make liposomal amphotericin B a preferred option over traditional antimony.
- Further evaluation of aminosidine is needed.
Abstract:
Visceral leishmaniasis is an endemic disease in the Mediterranean Basin. Children are one of the targets of the infection. Treatment usually requires parenteral injections of pentavalent antimony (Glucantime or Pentostam), but the high frequency of adverse events and the occurrence of primary or secondary resistance cases limit the use of these medications. Diamidines (Pentacarinat) or amphotericin B derivatives are alternatives to antimony. Unfortunately, pharmacokinetics and optimal dosage of diamidines are not well-known, and numerous adverse events are described. Liposomal preparations of amphotericin B enhance its efficiency and tolerance, and the duration of treatment may be reduced to 5 days. Moreover, primary resistance to amphotericin B is not described in immunocompetent children. Allopurinol associated with antimony seems no more efficient than antimony alone. Aminosidine is not evaluated.