Current and emerging medications for the treatment of leishmaniasis

ABSTRACT

Introduction: Leishmaniasis is a vector-borne neglected tropical disease which manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucocutaneous leishmaniasis (MCL). The current drugs are toxic, duration of treatment is long, there is regional variation in efficacy, and emergence of resistance is common.

Areas covered: This manuscript is based on literature derived from PubMed and reviews the current and emerging medications for the treatment of leishmaniasis. A single dose of liposomal amphotericin B (L-AmB) and multidrug therapy are the best options for VL in the Indian subcontinent (ISC), while a combination of pentavalent antimonials and paromomycin remains the treatment of choice for VL in Africa where efficacious and safe regimens are needed for HIV-VL coinfection. L-AmB at a total dose of 18–21 mg/kg is the recommended regimen for VL in the Mediterranean region, South America and for HIV-VL coinfection. Treatment of CL varies from observation, local or systemic therapy depending on severity of lesions, etiological species and its potential to develop into mucosal leishmaniasis.

Expert opinion: The monitoring of single-dose L-AmB and combination therapy in the ISC is essential. Effective short-course combination therapy is needed for the treatment of post-kala-azar dermal leishmaniasis and HIV-VL. Better evidence for treatment is still needed along with safer and shorter treatment options for CL and MCL.

KEYWORDS:

• Visceral leishmaniasis
• cutaneous leishmaniasis
• mucosal leishmaniasis
• treatment

Article highlights

• Efficacious and safer combination therapy is required for VL and HIV-VL coinfection in Africa.

• Monitoring of relapse and PKDL rates after single-dose L-AmB therapy and multidrug therapy is imperative as the ISC is aiming for elimination of VL.

• Shorter treatment regimens for PKDL is imperative for the elimination effort.

• Reinvestigating the use of fexinidazole and sitamaquine as a part of combination therapy needs to be encouraged.

• Newer treatment options and quality research is required for CL and ML.

• Combination therapy which is effective, short, and safe is the need of the hour for CL and ML.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work is supported by the National Institute of Allergy and Infectious Diseases (NIAID) via NIH 5U19AI074321-12.