Berman Jonathan
Office of Clinical and Regulatory Affairs, National Center For Complementary and Alternative Medicine, National Institutes of Health, 6707 Democracy Boulevard, Suite 401 Bethesda, MD 20892, USA.
Curr Opin Infect Dis. 2003 Oct;16(5):397-401. doi: 10.1097/00001432-200310000-00005.
The leishmaniases consist of cutaneous, mucosal, and visceral syndromes. The classic treatment is with pentavalent antimonials. The disadvantages of the antimonials are their requirement for intramuscular or intravenous injection each day for 20-28 days, their toxicity, and the recent development of resistance in regions such as India. Amphotericin B is a potent secondary agent, but is also compromised by its parenteral nature and toxicity. Clinical investigation of treatment agents from January 2000 to January 2003 is reviewed to determine if there are new agents that can be used.
A large number of pilot studies on visceral and cutaneous leishmaniasis have been performed. There can be more confidence in the visceral studies because visceral disease is incurable if untreated, and because large numbers of patients have been treated in highly endemic regions such as India. There is less confidence in pilot studies of the cutaneous disease, because most are uncontrolled, and there is a variable, and often high, cure rate without treatment.
Liposomal amphotericin B, which is injected infrequently and is easily tolerated, is virtually 100% effective for Indian visceral disease at a total dose of 15 mg/kg and is 90% effective at a dose of 5-10 mg/kg. The oral agent, miltefosine, is more than 95% effective for Indian visceral disease. Fluconazole treatment for 6 weeks speeds up the already-rapid cure rate of cutaneous disease due to Leishmania major.
利什曼病包括皮肤型、黏膜型和内脏型综合征。经典治疗方法是使用五价锑剂。锑剂的缺点包括需要每天进行20 - 28天的肌肉注射或静脉注射、具有毒性，以及近期在印度等地区出现了耐药性。两性霉素B是一种有效的二线药物，但同样因其肠道外给药方式和毒性而存在局限性。对2000年1月至2003年1月期间治疗药物的临床研究进行综述，以确定是否有可使用的新药物。
已针对内脏利什曼病和皮肤利什曼病开展了大量的试点研究。对于内脏利什曼病的研究可以更具信心，因为内脏型疾病若不治疗则无法治愈，且在印度等高流行地区已有大量患者接受了治疗。对于皮肤利什曼病的试点研究则信心不足，因为大多数研究未设对照，而且在未经治疗的情况下，治愈率存在差异且通常较高。
脂质体两性霉素B注射频率低且耐受性良好，总剂量为15mg/kg时对印度内脏利什曼病的疗效几乎达100%，剂量为5 - 10mg/kg时疗效为90%。口服药物米替福新对印度内脏利什曼病的疗效超过95%。氟康唑治疗6周可加快由硕大利什曼原虫引起的皮肤利什曼病本就较快的治愈率。
