title: An update on pharmacotherapy for leishmaniasis.
abstract: BACKGROUND
  Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis. The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic.
  
  
  METHODS
  A literature search on treatment of leishmaniasis was done on PubMed. Single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin (PM), or miltefosine + PM) are the treatment of choice for VL in the Indian subcontinent. A 17-day combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice for East African VL. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen for VL in the Mediterranean region and South America. Treatment of CL should be decided by the severity of clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis.
  
  
  CONCLUSIONS
  There is an urgent need to implement a single-dose L-AmB or combination therapy in the Indian subcontinent. Shorter and more acceptable regimens are needed for the treatment of post - kala-azar dermal leishmaniasis. Combination therapy with newer drugs needs to be tested in Africa. Due to the toxicity of systemic therapy, a trend toward local treatment for New World CL is preferred in patients without risk of mucosal disease.
authors.affiliation: Banaras Hindu University, Institute of Medical Sciences, Department of Medicine , Varanasi , India +91 542 2369632 ; drshyamsundar@hotmail.com.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
authors.forename: Jaya
authors.initials: J
authors.lastname: Chakravarty
mesh_terms: D017679:Cryotherapy; D004359:Drug Therapy, Combination; D006801:Humans; D006979:Hyperthermia, Induced; D007896:Leishmaniasis / Q000188:drug therapy*; D058069:Neglected Diseases / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D014344:Trypanocidal Agents / Q000627:therapeutic use*
chemical_list: D014344:Trypanocidal Agents
keywords: cutaneous leishmaniasis; kala azar; leishmaniasis; visceral leishmaniasis