The pentavalent antimonials
remain the first-line drugs for the treatment of leishmaniasis regardless their high toxicity, resistance emergency and treatment failure (Sundar, 2001; WHO, 2010).
Chemotherapy of this disease has relied mainly on pentavalent antimonials
, amphotericin B (AMB), and pentamidine (3).
have been recommended for the treatment of leishmaniasis for 50 years .
Treatment with the pentavalant antimonials
resulted in a dramatic resolution of all signs and symptoms within a few days.
Kala azar is treatable by a daily injection of pentavalent antimonials
for 30 days but early diagnosis makes the difference.
The choice of drugs (pentavalent antimonials
, amphotericin B, liposomal amphotericin B-Ambiosome, paromomycin, and miltefosine) has increased in the past decade, but there are numerous drawbacks to each of the treatments, such as difficulty to administer, length of treatment, toxicity, cost, and increasing parasitic resistance to treatment.
Parenteral therapy (pentavalent antimonials
, pentamidine isethionate, or amphotericin B) was not used because of adverse effects of these drugs.
There has been a dramatic increase in the number of cases of visceral Leishmanisis (VL) in north eastern India that do not respond to antimonials
are available only through an Investigational New Drug (IND) protocol from the Centers for Disease Control and Prevention.
Cutaneous leishmaniasis is generally sensitive to pentavalent antimonials
(Pentostam, sodium stibogluconate).
Among the many agents that have been used are pentavalent antimonials
(which cause some systemic toxicity and are used to treat the mucocutaneous form), pentamidine, amphotericin B (which is used primarily for visceral leishmaniasis), paromomycin (used for the visceral and cutaneous forms), cytokines such as interferon gamma (used for some mucocutaneous forms, including those caused by Leishmania braziliensis strains), oral antifungals such as ketoconazole, fluconazole, and itraconazole (which are well tolerated), and hipoxanthine (which inhibits purine anabolism and slows Leishmania proliferation).
of cases treated Calomel / Hydrargyrium submurias PM 137 Calomel - colocynth compound PM 79 Cathartic dose (unspecified) P 73 Magnesium sulphate P 73 Ipecac E 65 Antimony potassium tartrate E 62 Opium A 59 Jalap P 54 Antimonials
(powders/pills) E 48 Vesicatoires / blisters S 38 Rhei / rhubarb P 35 Colocynth / bitter cucumber P 33 Cataplasm / poultice S 33 Purgatives (unspecified) P 31 Emplastrum cantharidis S 31 Dover's powders (Ipecac and Opium) EA 25 Ricinus / castor oil P 23 Camphor S 22 Hydrargyrium (unspecified mercurial) M 21 Fomentations / baths S 20 Key to Drug Type A = analgesic or pain-killer; E = emetic; P = purgative or laxative; M = mercury; S = skin or topical