Liposomal amphotericin B in the treatment of visceral leishmaniasis in immunocompetent patients.
The leishmaniases are protozoan diseases caused by Leishmania parasites. The first-line treatment of its visceral forms is pentavalent antimony (meglumine antimoniate or sodium stibogluconate), but toxicity is frequent with this drug. Moreover antimony unresponsiveness is increasing in Leishmania infantum and L. donovani foci, both in immunocompetent and in immunosuppressed patients. Amphotericin B is a polyene macrolide antibiotic that binds to sterols in cell membranes. It is the most active antileishmanial agent in use. Its infusion-related and renal toxicity may be reduced by lipid-based delivery. Liposomal amphotericin B (AmBisome); Gilead Science, Paris, France) seems to be less toxic than other amphotericin B lipid formulations (Amphocil); Liposome Technology Inc., Menlo Park, CA, USA, Amphotec); Ben Venue Laboratories Inc., Bedford, OH, USA). Optimal drug regimens of AmBisome) vary from one geographical area to another. In the Mediterranean Basin, a total dose of 18 mg/kg (3 mg/kg on days 1-5 and 3 mg/kg on day 10) could be used as first-line treatment of visceral leishmaniasis in immunocompetent patients. In immunocompromised patients, especially those co-infected with HIV, relapses are frequent with AmBisome), as with other drugs.
Minodier
Philippe
P
Pediatric Emergency Unit, CHU Nord, Chemin des Bourrelly, 13915 Marseille Cedex 20, France. philippe.minodier@ap-hm.fr
Retornaz
Karine
K
Horelt
Alexia
A
Garnier
Jean-Marc
JM
D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D000967:Antimony Sodium Gluconate / Q000009:adverse effects / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D004338:Drug Combinations; D006801:Humans; D016867:Immunocompromised Host; D007891:Leishmania / Q000187:drug effects; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000276:immunology* / Q000469:parasitology; D008081:Liposomes; D008536:Meglumine / Q000009:adverse effects / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use; D010713:Phosphatidylcholines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010715:Phosphatidylglycerols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017211:Treatment Failure
D000981:Antiprotozoal Agents; D004338:Drug Combinations; D008081:Liposomes; D009942:Organometallic Compounds; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate