Current Treatment

Pentavalent antimonial compounds (notably sodium stibogluconate and meglumine antimoniate): These compounds induce many adverse effects (including headache, myalgia, nausea, transaminase elevation, reversible cardiotoxicity, and chemical and clinical pancreatitis) and their use has led to the development of drug resistance. At least 60% of infected people in India are resistant to these compounds.

Amphotericin B: This drug’s use is fraught with well-known adverse effects (including fever, malaise, nausea, vomiting, nephrotoxicity, and phlebitis). New lipid formulations of amphotericin B exhibit much less toxicity, but are expensive by developing world standards.

AmBisome: 5-day intravenous regimen. Liposomal Amphotericin B (encapsulated in liposomes) is well tolerated, but is expensive.

Miltefosine: The most recent treatment to come to market has been miltefosine, which has the advantage of being orally active in contrast to the treatments cited above. However, miltefosin is contraindicated in pregnancy. Women of child-bearing potential have to use effective contraception during and up to 3 months after treatment.

Paromomycin: An off-patent aminoglycoside antibiotic that is still marketed in the U.S. as an oral formulation to treat intestinal parasites. Paromomycin has been marketed worldwide, over many decades, for human and veterinary indications as parenteral and oral formulations.

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