Treatment of Leishmaniasis
- Classical treatment
For the treatment of Leishmaniasis the currently used drugs are
limited to four. The first line compounds are the two pentavalent
antimonials, sodium stibogluconate (Pentostam) and
meglumine antimoniate (Glucantime). They have been used for
the first time in 1947 and 1950, respectively. These drugs are
administered parenterally at a dosage of 10-20 mg and respectively
28 Sb/kg per day for 10 to 30 days. Failures and relapses occur in
all forms of leishmaniasis and constitute approximately 10-25% of
cases. If these drugs are not effective, the second line compounds
of pentamidine
(Lomidine) and amphotericine B (Fungizone) are
used, which have been introduced in 1940 and 1959,
respectively.
- Read hear about antimony resistant
leishmaniasis
- Experimental treatment
No new drugs have been developed recently although some
experimental drugs are going through clinical trials. These are:
- Allopurinol, a drug in use
for the treatment of gout. It is supposed to function as an
alternative substrate for the enzyme hypoxanthine guanine
phosphoribosyl transferase (HGPRTase), so allowing the
incorporation of allopurinol riboside into RNA, which leads to
the inhibition of protein synthesis in the parasite. It is also
on trial for the treatment of Chagas'disease
and the drug is now widely used for the treatment of
leishmaniasis in dogs.
- Ambisome, a formulation of amphotericine B in
liposomes. Owing to the high capacity of macrophages, the host
cell of the Leishmania parasite, for phagocytosis the drug is
specifically targeted and taken up by these cells. This will
increase efficay and reduce toxicity of the drug.
- Ketaconazole (Janssen Pharmaceutica), an inhibitor
of cytochrome P450 and the synthesis of the membrane sterol
egosterol and in use for the topical and sytemic treatment of
candidosis and other fungal infections,
also inhibits sterol synthesis in Leishmania and interferes
with its growth and division intracellular amastigotes. It is
on trial for the use in dogs and in humans in certain latin
American countries.
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Last updated: 8 October 1997.
created by :Fred
Opperdoes