Berman Jonathan
National Center for Complementary and Alternative Medicine, 6707 Democracy Boulevard, Bethesda, MD 20892, USA.
Expert Opin Investig Drugs. 2005 Nov;14(11):1337-46. doi: 10.1517/13543784.14.11.1337.
Leishmaniasis, which exists in both visceral and cutaneous forms, is currently treated with intramuscular antimony or intravenous amphotericin B. The primary unmet need is for oral therapy. Of the several drugs in clinical development, miltefosine is unique in being an oral agent with efficacy against both forms of the disease. Sitamaquine is an oral agent with substantial but not sufficient efficacy against visceral disease. Oral fluconazole has been shown to be more effective than placebo in one instance: for Leishmania major cutaneous disease from Saudi Arabia. Paromomycin is in widespread trial. Topical paromomycin formulations are being tested for cutaneous disease, and intramuscular paromomycin is in Phase III trial for Indian visceral disease. The most likely replacements for present therapy are oral miltefosine for many of the visceral and cutaneous syndromes, intramuscular paromomycin for visceral disease and topical paromomycin for some forms of cutaneous disease.
利什曼病有内脏型和皮肤型两种形式，目前通过肌肉注射锑剂或静脉注射两性霉素B进行治疗。主要未满足的需求是口服疗法。在几种处于临床开发阶段的药物中，米替福新是唯一一种对两种形式的疾病均有效的口服药物。司他马喹是一种对内脏疾病有显著但不足够疗效的口服药物。口服氟康唑仅在一个实例中显示比安慰剂更有效：用于治疗来自沙特阿拉伯的硕大利什曼原虫引起的皮肤疾病。巴龙霉素正在广泛试验。局部用巴龙霉素制剂正在针对皮肤疾病进行测试，肌肉注射巴龙霉素针对印度内脏疾病正处于III期试验。目前治疗方法最有可能的替代药物是：对许多内脏和皮肤综合征使用口服米替福新，对内脏疾病使用肌肉注射巴龙霉素，对某些形式的皮肤疾病使用局部用巴龙霉素。
