Drug combinations for visceral leishmaniasis.
OBJECTIVE
Several attempts have been made to combine drugs for treating visceral leishmaniasis, but only recently have effective drugs become available and combinations been tested systematically.


RESULTS
Sequential treatments with liposomal amphotericin B followed by miltefosine or paromomycin (as short as 7 days), as well as the concomitant administration of miltefosine and paromomycin (for 10 days) are very effective in India (>95%). Sodium stibogluconate plus paromomycin for 17 days is more than 90% effective in East Africa. The shortened combination regimens are cost-effective in India. No combination has been tested so far in Brazil, Nepal and Bangladesh, although studies may be expected in the near future. No cost-effectiveness analysis has been done as yet outside India.


CONCLUSIONS
There is evidence of high efficacy and benefits with sequential and co-administration treatments in India. More studies are needed in other endemic areas. Introducing combinations and scaling up their use will be challenging. Experience acquired with malaria may be useful. Proper monitoring of use and effects (efficacy and safety) will be required. Currently there are no options for fixed-dose combination treatments for leishmaniasis.
Olliaro
Piero L
PL
UNICEF/UNPD/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland. olliarop@who.int
D000666:Amphotericin B / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D000967:Antimony Sodium Gluconate / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000191:economics; D010303:Paromomycin / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D010767:Phosphorylcholine / Q000031:analogs & derivatives / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use
D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D010303:Paromomycin; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate