Chapter 07 -- Global Cutaneous and Systemic Leishmaniasis Market Analysis 2013 - 2017 & Forecast 2018 - 2028, By Drug Class Based on the type, the cutaneous and systemic leishmaniasis market is segmented into pentavalent antimonials
, antifungal drugs, and anti-lesihmanial/antimicrobial drugs.
Monotherapy being no longer effective, we suggest multidrug therapy while granting priority to pentavalent antimonials
(glucantime or pentostam) as first-line drugs in combination with second-choice compounds including paromomycin.
However drug resistance has been increasingly documented with a cure rate not beyond 80%.5 Resistance to antimonials
lead to treatment failure in particular to anthroponotic cutaneous leishmaniasis.6 Miltefosine appears promising in the treatment of cutaneous leishmaniasis.7 It has been approved by FDA for infections by Leishmania (V.) braziliensis, L.
The conventional preparation amphotericin B deoxycholate is the preferred drug in resource limited establishments, while pentavalent antimonials
are the first choice outside Asia.
The World Health Organization (WHO) recommendations for the treatment of CL are intralesional or systemic antimonials
, according to the species and the clinical features.11
As expected, clinicians prescribed preferentially amphotericin B rather than pentavalent antimonials
when treating coinfected patients.
Drug resistance has been reported in various species of Leishmania against various antileishmanial drugs like antimonials
, amphotericin B, pentamidine, miltefosine, and so forth.
Alving and coworkers  reported the leishmanicidal activity of pentavalent antimonials
encapsulated in liposomes in the treatment of hamsters infected with Leishmania donovani and demonstrated a reduction in the parasitic load 700-fold larger with the liposome formulation than with the free drug.
Machado et al., "Successful treatment of refractory cutaneous leishmaniasis with GM-CSF and antimonials
," The American Journal of Tropical Medicine and Hygiene, vol.
Since the 1940s, chemotherapy of leishmaniasis has been based on the use of pentavalent antimonials
as first choice drugs, such as sodium stibogluconate (Pentostan[R]) and meglumine antimoniate (Glucantime[R]) .
The first-line drugs, including amphotericin B and pentavalent antimonials
, have serious side effects .
The treatments currently in use as prime therapy for leishmaniasis include meglumine antimoniate (Glucantime), in addition to pentavalent antimonials
sodium stibogluconate (Pentostam), but they are harmful to some extent, require prolong parenteral administration courses and have powerful side effects .