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However, appropriate therapy is not well defined; success has been sparsely reported with the simultaneous use of azoles, flucytosine, pentamidine, sulfazidine, macrolide antimicrobial drugs, phenothiazines, and miltefosine (2,7,10).
The seven new anti-infectives and their indications are dalbavancin (Dalvance) for treatment of skin infections caused by gram-positive organisms; efinaconazole (Jublia), for treatment of fungal infections of the toenails; miltefosine (Impavido) for treatment of visceral, cutaneous, and mucosal infections by various Leishmania species; oritavancin (Orbactiv) for skin infections caused by gram-positive bacteria; peramivir (Rapivab), for acute uncomplicated influenza; tavaborole (Kerydin) for treatment of fungal infections of the toenails; and tedizolid (Sivextro) for treatment of bacterial skin infections.
Although miltefosine caused severe toxicity in two animal species, visceral and cutaneous leishmaniasis may be life threatening for the mother and can cause severe developmental toxicity in the embryo and fetus, so the drug should not be withheld in pregnancy.
Other drugs such as pentamidine, amphotericin B and miltefosine have limited use due to their high cost, severe side effects or resistance (Sanchez-Canete et al.
New treatment approach in Indian visceral leishmaniasis: Single-dose liposomal amphotericin B followed by short-course oral miltefosine.
From case detection and management to implementation of new treatment modalities, including liposomal amphotericin B (AmBisome) in monotherapy and several combination therapies - with AmBisome, miltefosine, and paromomycin - the project covers primary and secondary healthcare levels in the public, not-for-profit, and private sectors.
The infected culture was seeded onto 384-well plates and incubated in the presence of serially diluted miltefosine or amphotericin B, as positive control, and in the absence of drugs, as negative control.
A parenteral formulation of the aminoglycoside paromomycin (aminosidine) and the orally available alkylphospholipid miltefosine are also potential treatments for VL (Sundar 2003).
Clinical tests in India are proving encouraging for miltefosine and paromomycin, but these results have yet to be finalized for registration.
Within this ambitious, multi-faceted project, OneWorld Health will investigate the use of combination therapies with miltefosine, paromomycin and AmBisome[R] in the private sector in India to control and support VL elimination.
As positive controls, Glucantime was purchased from Aventis, and Miltefosine was kindly provided by /Eterna Zentaris Inc.