Banaras Hindu University, Institute of Medical Sciences, Department of Medicine, Varanasi 221 005, India.
Expert Opin Pharmacother. 2013 Jan;14(1):53-63. doi: 10.1517/14656566.2013.755515. Epub 2012 Dec 21.
Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL). The treatment of VL is challenging. The duration of treatment is long, and drugs are toxic thereby needing monitoring and hospitalization.
Novel therapies such as single dose of liposomal amphotericin B (L-AmB) and multidrug therapy are important breakthrough for VL in the Indian subcontinent and have been recommended as the treatment of choice in this region. African Leishmania donovani is less susceptible to L-AmB, miltefosine and paromomycin as compared to the Indian strains, and the treatment of choice remains a 17-day combination therapy of pentavalent antimonials (SB(v)) and paromomycin. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen in the Mediterranean region and South America. It is also the treatment of choice for HIV-VL coinfection. Treatment of CL should be decided by the clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. A literature search on treatment of leishmaniasis was done on PubMed and through Google.
There is an urgent need for exploratory studies with short course, highly efficient regimens such as single dose L-AmB or combination therapy for all the endemic regions of VL. Shorter and more acceptable regimens are needed for the treatment of post-kala-azar dermal leishmaniasis. Treatment of CL remains one of the neglected areas of leishmaniasis as data are scarce and drawn from uncontrolled studies.
利什曼病主要表现为内脏利什曼病（VL）、皮肤利什曼病（CL）和黏膜皮肤利什曼病（MCL）。VL 的治疗具有挑战性。治疗时间长，药物有毒性，因此需要监测和住院治疗。
在印度次大陆，单剂量脂质体两性霉素 B（L-AmB）和多药物治疗等新疗法是 VL 的重要突破，已被推荐为该地区的首选治疗方法。与印度株相比，非洲利什曼原虫对 L-AmB、米替福新和巴龙霉素的敏感性较低，因此首选治疗方法仍然是 17 天的五价锑（SB(v)）和巴龙霉素联合治疗。在地中海地区和南美洲，推荐的方案是总剂量为 18-21mg/kg 的 L-AmB。它也是 HIV-VL 合并感染的首选治疗方法。CL 的治疗应根据临床病变、病因物种及其发展为黏膜利什曼病的潜力来决定。在 PubMed 上和通过谷歌进行了有关利什曼病治疗的文献检索。
迫切需要在所有 VL 流行地区进行探索性研究，寻找短期、高效的方案，如单剂量 L-AmB 或联合治疗。需要为治疗后黑热病皮肤利什曼病开发更短和更可接受的方案。CL 的治疗仍然是利什曼病被忽视的领域之一，因为数据稀缺且来自非对照研究。
