Drug regimens for visceral leishmaniasis in Mediterranean countries

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 setti...

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Bibliographic Details
Published in:Tropical medicine & international health 2008-10, Vol.13 (10), p.1272-1276
Main Authors: Gradoni, Luigi, Soteriadou, Ketty, Louzir, Hecmi, Dakkak, Allal, Toz, Seray Ozensoy, Jaffe, Charles, Dedet, Jean-Pierre, Campino, Lenea, Cañavate, Carmen, Dujardin, Jean-Claude
Format: Article
Language:English
Subjects:
Adolescent
Adult
Africa, Northern
Aged
Aged, 80 and over
Amphotericin B
Amphotericin B - economics
Amphotericin B - therapeutic use
amphotéricine B
Anfotericina B
Animals
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antifungal agents
antimoine pentavalent
antimonio pentavalente
Antimony Sodium Gluconate
Antimony Sodium Gluconate - economics
Antimony Sodium Gluconate - therapeutic use
Antiprotozoal Agents
Antiprotozoal Agents - economics
Antiprotozoal Agents - therapeutic use
Biological and medical sciences
Child
Child, Preschool
Clinical Protocols
Drug therapy
Europe
Female
General aspects
Human protozoal diseases
Humans
Immunocompromised Host
Immunocompromised Host - drug effects
Infectious diseases
Israel
Leishmania infantum
leishmaniasis visceral Mediterránea
Leishmaniasis, Visceral
Leishmaniasis, Visceral - drug therapy
Leishmaniasis, Visceral - economics
Leishmaniasis, Visceral - immunology
leishmaniose viscérale méditerranéenne
Leshmaniasis
Life Sciences
Male
Medical sciences
Medication
Mediterranean visceral leishmaniasis
Meglumine
Meglumine - economics
Meglumine - therapeutic use
Microbiology and Parasitology
Middle Aged
Middle East
miltefosine
miltéfosine
Parasitic diseases
Parasitology
pentavalent antimony
Pharmaceutical sciences
Pharmacology. Drug treatments
Protozoal diseases
terapia
therapeutics
therapy
thérapie
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Summary: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 (greater-than-or-equal95%) 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.
ISSN:1360-2276
0365-6527
1365-3156
DOI:10.1111/j.1365-3156.2008.02144.x