Liposomal amphotericin B for the treatment of visceral leishmaniasis.
During the past decade, liposomal amphotericin B has been used with increasing frequency to treat visceral leishmaniasis (VL). The World Health Organization convened a workshop to review current knowledge and to develop guidelines for liposomal amphotericin B use for VL. In Europe, liposomal amphotericin B is widely used to treat VL. In Africa and Asia, the VL disease burden is high and drug access is poor; liposomal amphotericin B is available only through preferential pricing for nonprofit groups in East Africa. Clinical trials and experience demonstrate high efficacy and low toxicity for liposomal amphotericin B (total dose, 20 mg/kg) in immunocompetent patients with VL. Combination trials in areas with antileishmanial drug resistance, and treatment and secondary prophylaxis trials in VL-human immunodeficiency virus-coinfected patients, are important to safeguard the current armamentarium and to optimize regimens. The public health community should work to broaden access to preferential liposomal amphotericin B pricing by public sector VL treatment programs.
Bern
Caryn
C
Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Adler-Moore
Jill
J
Berenguer
Juan
J
Boelaert
Marleen
M
den Boer
Margriet
M
Davidson
Robert N
RN
Figueras
Concepcion
C
Gradoni
Luigi
L
Kafetzis
Dimitris A
DA
Ritmeijer
Koert
K
Rosenthal
Eric
E
Royce
Catherine
C
Russo
Rosario
R
Sundar
Shyam
S
Alvar
Jorge
J
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000666:Amphotericin B / Q000008:administration & dosage / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000818:Animals; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004337:Drug Carriers; D016527:Drug Costs; D006287:Health Planning Guidelines; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy*; D008081:Liposomes; D016896:Treatment Outcome
D000981:Antiprotozoal Agents; D004337:Drug Carriers; D008081:Liposomes; C068538:liposomal amphotericin B; D000666:Amphotericin B