title: Leishmaniasis: an update of current pharmacotherapy.
abstract: BACKGROUND
  Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL). The treatment of VL is challenging. The duration of treatment is long, and drugs are toxic thereby needing monitoring and hospitalization.
  
  
  METHODS
  Novel therapies such as single dose of liposomal amphotericin B (L-AmB) and multidrug therapy are important breakthrough for VL in the Indian subcontinent and have been recommended as the treatment of choice in this region. African Leishmania donovani is less susceptible to L-AmB, miltefosine and paromomycin as compared to the Indian strains, and the treatment of choice remains a 17-day combination therapy of pentavalent antimonials (SB(v)) and paromomycin. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen in the Mediterranean region and South America. It is also the treatment of choice for HIV-VL coinfection. Treatment of CL should be decided by the clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. A literature search on treatment of leishmaniasis was done on PubMed and through Google.
  
  
  CONCLUSIONS
  There is an urgent need for exploratory studies with short course, highly efficient regimens such as single dose L-AmB or combination therapy for all the endemic regions of VL. Shorter and more acceptable regimens are needed for the treatment of post-kala-azar dermal leishmaniasis. Treatment of CL remains one of the neglected areas of leishmaniasis as data are scarce and drawn from uncontrolled studies.
authors.affiliation: Banaras Hindu University, Institute of Medical Sciences, Department of Medicine, Varanasi 221 005, India. drshyamsundar@hotmail.com
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.forename: Jaya
authors.initials: J
authors.lastname: Chakravarty
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D007893:Leishmania donovani / Q000187:drug effects; D007898:Leishmaniasis, Visceral / Q000188:drug therapy*; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000627:therapeutic use*; D021261:Parasitic Sensitivity Tests; D010303:Paromomycin / Q000627:therapeutic use*; D010767:Phosphorylcholine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D013045:Species Specificity; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D010303:Paromomycin; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate