a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India.
Expert Opin Pharmacother. 2019 Jul;20(10):1251-1265. doi: 10.1080/14656566.2019.1609940. Epub 2019 May 7.
INTRODUCTION: Leishmaniasis is a vector-borne neglected tropical disease which manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucocutaneous leishmaniasis (MCL). The current drugs are toxic, duration of treatment is long, there is regional variation in efficacy, and emergence of resistance is common. AREAS COVERED: This manuscript is based on literature derived from PubMed and reviews the current and emerging medications for the treatment of leishmaniasis. A single dose of liposomal amphotericin B (L-AmB) and multidrug therapy are the best options for VL in the Indian subcontinent (ISC), while a combination of pentavalent antimonials and paromomycin remains the treatment of choice for VL in Africa where efficacious and safe regimens are needed for HIV-VL coinfection. L-AmB at a total dose of 18-21 mg/kg is the recommended regimen for VL in the Mediterranean region, South America and for HIV-VL coinfection. Treatment of CL varies from observation, local or systemic therapy depending on severity of lesions, etiological species and its potential to develop into mucosal leishmaniasis. EXPERT OPINION: The monitoring of single-dose L-AmB and combination therapy in the ISC is essential. Effective short-course combination therapy is needed for the treatment of post-kala-azar dermal leishmaniasis and HIV-VL. Better evidence for treatment is still needed along with safer and shorter treatment options for CL and MCL.
简介:利什曼病是一种由媒介传播的被忽视的热带病,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)。目前的药物具有毒性,治疗时间长,疗效存在地域差异,而且耐药性普遍存在。
涵盖领域:本文献基于来自 PubMed 的文献,综述了目前和新出现的治疗利什曼病的药物。对于印度次大陆(ISC)的 VL,单剂量脂质体两性霉素 B(L-AmB)和多药治疗是最佳选择,而五价锑和巴龙霉素的联合用药仍然是非洲 VL 的治疗选择,在那里需要有效的和安全的方案来治疗 HIV-VL 合并感染。对于地中海地区、南美洲和 HIV-VL 合并感染的 VL,推荐的治疗方案是总剂量为 18-21mg/kg 的 L-AmB。CL 的治疗方法因病变的严重程度、病因物种及其发展为黏膜利什曼病的潜在风险而有所不同,包括观察、局部或全身治疗。
专家意见:在 ISC 中监测单剂量 L-AmB 和联合治疗至关重要。需要有效的短期联合治疗来治疗 post-kala-azar 皮肤利什曼病和 HIV-VL。还需要更好的治疗证据,以及更安全和更短的 CL 和 MCL 治疗选择。
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