Jha Rajesh Kumar, Sah Ajit Kumar, Shah Dev Kumar, Sah Phoolgen
Department of Pharmacology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
JNMA J Nepal Med Assoc. 2013 Oct-Dec;52(192):645-51.
Visceral leishmaniasis is the disease of poor; however availability of only expensive treatment of this disease impinges the socioeconomic condition of those affected. If untreated, almost all cases of visceral leishmaniasis are fatal. The demonstration of the leishmania donovani bodies from the tissue aspirates or serological tests confirms the diagnosis of the disease. Pentavalent antimony, amphotericin B, paromomycin, diamine pentamidine, miltefosine, sitamaquine and some new combinations are integrated in the limited therapeutic armoury for treatment of visceral leishmaniasis. The recommended first and second line therapy in the Indian sub-continent is miltefosine and amphotericin B respectively.Pentavalent antimonial, preceding first line therapy, has been replaced by miltefosine due to former increasing failure rate and toxicity.The problem of drug resistance, some of the serious drug toxicities along with high-priced drugs extends challenges equally to pharmaceutical companies and medical practitioners. More research on adverse drug events for the existing drugs and efforts to develop safer and effective drugs to counter resistance outbreaks for the successful management of visceral leishmaniasis are needed.
内脏利什曼病是穷人易患的疾病；然而，这种疾病仅有的昂贵治疗方法影响了患者的社会经济状况。如果不治疗，几乎所有内脏利什曼病病例都会致命。从组织抽吸物中发现利杜体或进行血清学检测可确诊该病。五价锑、两性霉素B、巴龙霉素、二脒那嗪、米替福新、西他喹啉以及一些新的联合用药被纳入了治疗内脏利什曼病的有限治疗手段中。在印度次大陆，推荐的一线和二线治疗药物分别是米替福新和两性霉素B。由于五价锑的失败率和毒性不断增加，在一线治疗之前使用的五价锑已被米替福新取代。耐药性问题、一些严重的药物毒性以及高价药物同样给制药公司和医生带来了挑战。需要对现有药物的药物不良事件进行更多研究，并努力开发更安全有效的药物以应对耐药性爆发，从而成功治疗内脏利什曼病。
