What is the role of amphotericin B in the treatment of leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Amphotericin B is effective against pentavalent antimony-resistant mucocutaneous disease and visceral leishmaniasis. Its use is limited because of its toxic adverse effect profile. The newer lipid preparations (amphotericin B lipid complex, liposomal amphotericin B, and amphotericin B colloidal dispersion) are more active, better tolerated, and are being used as first-line therapy against visceral leishmaniasis, but the response with cutaneous disease has been mixed, and treatment is costly.

Liposomal amphotericin B is the drug of choice for visceral leishmaniasis because of its shorter course and lower toxicity.

In an open-label comparative study, Sundar et al found that the efficacy of a single infusion of liposomal amphotericin B was equivalent to a conventional amphotericin B infusion (15 alternate-day infusions) for visceral leishmaniasis. [31] Additionally, the liposomal group was less expensive and exhibited fewer infusion-related adverse effects (eg, fever, rigors) compared with conventional amphotericin B. [31]

A separate study by Sundar et al suggested that varied combinations of drugs, including liposomal amphotericin B, miltefosine, and paromomycin (for durations as short as 7-10 days), provide effective, safer, and cheaper regimens compared with the conventional 30-day amphotericin B regimen for visceral leishmaniasis. [32]

A single-dose treatment with liposomal amphotericin B has shown a 91% cure rate in India. [33] In endemic areas of north India, liposomal amphotericin is used in combination with miltefosine. [34] A short-course regimen consisting of a single dose of liposomal amphotericin followed by 7-14 days of miltefosine has resulted in cure rates of over 90%. [34] The single-dose liposomal amphotericin B regimen has become affordable after its inclusion in India’s Kala-azar Programme, assisted by drug donations facilitated by the WHO.

Response to liposomal amphotericin B may be suboptimal in patients infected with human immunodeficiency virus (HIV). [35]


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