Minodier P, Faraut-Gambarelli F, Piarroux R, Gire C, Garnier J M, Dumon H
Service de pédiatrie, CHU Nord, Marseille, France.
Arch Pediatr. 1999 Jan;6(1):59-66. doi: 10.1016/s0929-693x(99)80076-1.
Visceral leishmaniasis is an endemic disease in the Mediterranean Basin. Children are one of the targets of the infection. Treatment usually requires parenteral injections of pentavalent antimony (Glucantime or Pentostam), but the high frequency of adverse events and the occurrence of primary or secondary resistance cases limit the use of these medications. Diamidines (Pentacarinat) or amphotericin B derivatives are alternatives to antimony. Unfortunately, pharmacokinetics and optimal dosage of diamidines are not well-known, and numerous adverse events are described. Liposomal preparations of amphotericin B enhance its efficiency and tolerance, and the duration of treatment may be reduced to 5 days. Moreover, primary resistance to amphotericin B is not described in immunocompetent children. Allopurinol associated with antimony seems no more efficient than antimony alone. Aminosidine is not evaluated.
内脏利什曼病在地中海盆地是一种地方病。儿童是感染的目标人群之一。治疗通常需要肠胃外注射五价锑（葡糖酸锑钠或喷他脒），但不良事件的高发生率以及原发性或继发性耐药病例的出现限制了这些药物的使用。双脒类药物（喷他脒）或两性霉素B衍生物是锑剂的替代药物。不幸的是，双脒类药物的药代动力学和最佳剂量尚不明确，并且有大量不良事件的报道。两性霉素B脂质体制剂提高了其疗效和耐受性，治疗时间可缩短至5天。此外，在免疫功能正常的儿童中未发现对两性霉素B的原发性耐药。与锑联合使用的别嘌呤醇似乎并不比单独使用锑更有效。未对氨基糖苷进行评估。
