title: [Therapy of leishmaniasis in France: consensus on proposed guidelines].
abstract: Because it relies on potentially toxic, difficult-to-handle, or expensive compounds the therapy of leishmaniasis is still a complex issue in 2010, especially for visceral leishmaniasis in immuno-suppressed subjects, or in patients with cutaneous and mucosal involvement. This induces a wide diversity of observed therapeutic practices, some being sub-optimal. The Société de Pathologie Exotique organised a meeting dedicated to the therapy of leishmaniasis in France that led to the first consensus on therapeutic guidelines. Liposomal amphotericin B is the first-line option for visceral leishmaniasis both in immunocompetent, and immunosuppressed patients (cumulated doses of 20 mg/kg and 30-40 mg/kg, respectively). Secondary prophylaxis with either liposomal amphotericin B, pentamidine or meglumine antimoniate is proposed to patients with heavy immunosuppression until immunity has been restored for at least 6 months. While the efficacy of new topical formulations of paromomycin is being tested, patients with Old World cutaneous leishmaniasis may be left untreated, or be administered a combination of superficial cryotherapy plus intralesional antimony, or even--in complex situations--receive systemic therapy. The efficacy of a short course of pentamidine (L. guyanensis/L. panamensis) and a 20-day schedule of meglumine antimoniate (L. braziliensis) is solidly established. However, in well-defined situations, local therapy of New World cutaneous leishmaniasis is now considered acceptable.
authors.affiliation: Université Paris 6, UMR945 47, hôpital Pitié-Salpêtrière, service de parasitologie-mycologie, boulevard de l'hôpital, 75651 Paris cedex 13, France. pierre.buffet@psl.aphp.fr
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Buffet
authors.forename: Éric
authors.initials: É
authors.lastname: Rosenthal
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gangneux
authors.forename: Edward
authors.initials: E
authors.lastname: Lightburne
authors.forename: Pierre
authors.initials: P
authors.lastname: Couppié
authors.forename: Gloria
authors.initials: G
authors.lastname: Morizot
authors.forename: Laurence
authors.initials: L
authors.lastname: Lachaud
authors.forename: Pierre
authors.initials: P
authors.lastname: Marty
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dedet
mesh_terms: D005602:France; D006801:Humans; D007896:Leishmaniasis / Q000188:drug therapy*; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy; D007898:Leishmaniasis, Visceral / Q000188:drug therapy