Liposomal Amphotericin B for the Treatment of Visceral Leishmaniasis

• Published in: Clinical infectious diseases 2006-10, Vol.43 (7), p.917-924
• Main Authors: Saravolatz, Louis D., Bern, Caryn, Adler-Moore, Jill, Berenguer, Juan, Boelaert, Marleen, den Boer, Margriet, Davidson, Robert N., Figueras, Concepcion, Gradoni, Luigi, Kafetzis, Dimitris A., Ritmeijer, Koert, Rosenthal, Eric, Royce, Catherine, Russo, Rosario, Sundar, Shyam, Alvar, Jorge
• Format: Article
• Language: English
• Subjects: AIDS-Related Opportunistic Infections - prevention & control; Amphotericin B - administration & dosage; Amphotericin B - economics; Amphotericin B - pharmacokinetics; Amphotericin B - therapeutic use; Animals; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antiparasitic agents; Antiprotozoal Agents - administration & dosage; Antiprotozoal Agents - pharmacokinetics; Antiprotozoal Agents - therapeutic use; Biological and medical sciences; Clinical trials; Clinical Trials as Topic; Dosage; Drug Carriers; Drug Costs; Drug resistance; Drug therapy; Epidemiology; Health Planning Guidelines; Highly active antiretroviral therapy; Human protozoal diseases; Humans; Infectious diseases; Leishmaniasis; Leishmaniasis, Visceral - drug therapy; Leshmaniasis; Lipids; Liposomes; Medical sciences; Neglected diseases; Parasitic diseases; Pharmacology. Drug treatments; Protozoal diseases; Reviews of Anti-Infective Agents; Treatment Outcome; Tropical medicine; Visceral leishmaniasis; Zoonoses
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/507530

During the past decade, liposomal amphotericin B has been used with increasing frequency to treat visceral leishmaniasis (VL). The World Health Organization convened a workshop to review current knowledge and to develop guidelines for liposomal amphotericin B use for VL. In Europe, liposomal amphotericin B is widely used to treat VL. In Africa and Asia, the VL disease burden is high and drug access is poor; liposomal amphotericin B is available only through preferential pricing for nonprofit groups in East Africa. Clinical trials and experience demonstrate high efficacy and low toxicity for liposomal amphotericin B (total dose, 20 mg/kg) in immunocompetent patients with VL. Combination trials in areas with antileishmanial drug resistance, and treatment and secondary prophylaxis trials in VL-human immunodeficiency virus-coinfected patients, are important to safeguard the current armamentarium and to optimize regimens. The public health community should work to broaden access to preferential liposomal amphotericin B pricing by public sector VL treatment programs.