title: Drug regimens for visceral leishmaniasis in Mediterranean countries.
abstract: Until the early 1990s, pentavalent antimony was the only documented first-line drug employed for the treatment of zoonotic visceral leishmaniasis (VL) in the Mediterranean, with reported cure rates exceeding 95% in immunocompetent patients. The emergence of antimony resistance in other endemic settings and the increase in drug options have stimulated re-evaluation of the current therapeutic approaches and outcomes in Mediterranean countries. A scientific consortium ('LeishMed' network) collected updated information from collaborating clinical health centres of 11 endemic countries of Southern Europe, Northern Africa and the Middle East. In contrast with the previous situation, VL is now treated differently in the region, basically through three approaches: (1) In Northern Africa and in part of the Middle East, pentavalent antimony is still the mainstay for therapy, with no alternative drug options for treating relapses; (2) In some European countries and Israel, both pentavalent antimony and lipid-associated amphotericin B (AmB) formulations are used as first-line drugs, although in different patients' categories; (3) In other countries of Europe, mainly liposomal AmB is employed. Importantly, cure rates exhibited by different drugs, including antimonials in areas where they are still in routine use, are similarly high (>/=95%) in immunocompetent patients. Our findings show that antimony resistance is not an emerging problem in the Mediterranean. A country's wealth affects the treatment choice, which represents a balance between drug efficacy, toxicity and cost, and costs associated with patient's care.
authors.affiliation: Istituto Superiore di Sanità, Rome, Italy. luigi.gradoni@iss.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Gradoni
authors.forename: Ketty
authors.initials: K
authors.lastname: Soteriadou
authors.forename: Hecmi
authors.initials: H
authors.lastname: Louzir
authors.forename: Allal
authors.initials: A
authors.lastname: Dakkak
authors.forename: Seray Ozensoy
authors.initials: SO
authors.lastname: Toz
authors.forename: Charles
authors.initials: C
authors.lastname: Jaffe
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dedet
authors.forename: Lenea
authors.initials: L
authors.lastname: Campino
authors.forename: Carmen
authors.initials: C
authors.lastname: Cañavate
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Dujardin