Therapy of leishmaniasis in France: consensus on proposed guidelines

Because it relies on potentially toxic, difficult-to-handle, or expensive compounds the therapy of leishmaniasis is still a complex issue in 2010, especially for visceral leishmaniasis in immuno-suppressed subjects, or in patients with cutaneous and mucosal involvement. This induces a wide diversity...

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Bibliographic Details
Published in:La Presse médicale (1983) 2011-02, Vol.40 (2), p.173-184
Main Authors: Buffet, Pierre A, Rosenthal, Éric, Gangneux, Jean-Pierre, Lightburne, Edward, Couppié, Pierre, Morizot, Gloria, Lachaud, Laurence, Marty, Pierre, Dedet, Jean-Pierre
Format: Article
Language:fre
Subjects:
France
Humans
Leishmaniasis - drug therapy
Leishmaniasis, Cutaneous - drug therapy
Leishmaniasis, Visceral - drug therapy
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Summary:Because it relies on potentially toxic, difficult-to-handle, or expensive compounds the therapy of leishmaniasis is still a complex issue in 2010, especially for visceral leishmaniasis in immuno-suppressed subjects, or in patients with cutaneous and mucosal involvement. This induces a wide diversity of observed therapeutic practices, some being sub-optimal. The Société de Pathologie Exotique organised a meeting dedicated to the therapy of leishmaniasis in France that led to the first consensus on therapeutic guidelines. Liposomal amphotericin B is the first-line option for visceral leishmaniasis both in immunocompetent, and immunosuppressed patients (cumulated doses of 20 mg/kg and 30-40 mg/kg, respectively). Secondary prophylaxis with either liposomal amphotericin B, pentamidine or meglumine antimoniate is proposed to patients with heavy immunosuppression until immunity has been restored for at least 6 months. While the efficacy of new topical formulations of paromomycin is being tested, patients with Old World cutaneous leishmaniasis may be left untreated, or be administered a combination of superficial cryotherapy plus intralesional antimony, or even--in complex situations--receive systemic therapy. The efficacy of a short course of pentamidine (L. guyanensis/L. panamensis) and a 20-day schedule of meglumine antimoniate (L. braziliensis) is solidly established. However, in well-defined situations, local therapy of New World cutaneous leishmaniasis is now considered acceptable.
ISSN:2213-0276
DOI:10.1016/j.lpm.2010.09.023