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Drug Resistance in Leishmania Parasites pp 159–176Cite as

Visceral Leishmaniasis

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Abstract

Pentavalent antimonials (SbV) have been the sheet anchor of therapy for leishmaniasis for >75 years. In the early 1980s, it was realized that a significant subset of patients with visceral leishmaniasis were not responding to SbV in the state of Bihar, India. Revised recommendation using ten times more drug provided a transient reprieve; however, a large proportion of patients in India and to some extent in Nepal remained unresponsive to SbV. Diverse studies have suggested emergence of SbV refractory strains in India. Attempts to find a marker of unresponsiveness have failed so far. Alternative therapeutic options include conventional amphotericin-B or its lipid formulations, oral miltefosine, and paromomycin and short course multidrug therapy. In the Indian subcontinent, the only recommended monotherapy is a single dose of liposomal amphotericin-B (L-AMB, dose 10 mg/kg) which is efficacious, safe, and ensures complete compliance. Multidrug therapy has high efficacy, short course, less toxicity, and prevents development of resistance. If these scarce antileishmanial drugs are to be protected from going down the lane of SbV, multidrug, short course, affordable treatment of VL should be evolved with access to all.

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  1. Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

    Shyam Sundar & Jaya Chakravarty

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  1. Institute of Experimental Medicine, Universidad Central de Venezuela, Caracas, Venezuela

    Alicia Ponte-Sucre

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    Maritza Padrón-Nieves

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Sundar, S., Chakravarty, J. (2018). Visceral Leishmaniasis. In: Ponte-Sucre, A., Padrón-Nieves, M. (eds) Drug Resistance in Leishmania Parasites. Springer, Cham. https://doi.org/10.1007/978-3-319-74186-4_7

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