Recently studies show that effective oral drugs for visceral leishmaniasis or Kala Azar has been developed. Bedore proceeding to this, leu us first understand how that developed.

Antimony Pentavalent Pesticide Agents 

 Basic treatments for leishmaniasis are pentavalent antimony compounds first introduced in the 1930s. Depending on the species and region, the cure rate for leishmaniasis. In general, 80 to 100% have been reported. Sodium stibogluconate is only available from the CDC under the New Drug Investigation Protocol (IND). However, this effect has not been reproduced in the treatment of mucosal leishmaniasis. In a follow-up study of IV sodium stibogluconate involving US servicemen with cutaneous leishmaniasis due to  panamensis, the 10-day treatment efficacy was confirmed, with a significantly reduced adverse event profile. It was included in the standard 20-day course. Unfortunately, resistance to this agent is increasing. 

 Amphotericin B 

 Amphotericin B is effective against diseases of the skin and mucous membranes, pentavalent antimony and visceral leishmaniasis. Its use is limited due to its toxic side effect profile are more active, better tolerated and are used as a first-line treatment for visceral leishmaniasis, but the response to skin diseases has decreased and the processing is very expensive. The response to liposomal amphotericin B may be suboptimal in patients infected with human immunodeficiency virus (HIV). 

 Oral miltefosine 

 The discovery of an appropriate, oral and well-tolerated treatment for oral drugs for visceral leishmaniasis has made it possible to treat a wide range of this disease in developing countries. Miltefosine is the only oral medication that is effective against leishmaniasis. Oral treatment of 2.5 mg/kg/day for 46 weeks is generally well tolerated. Another study in visceral leishmaniasis, comparing oral miltefosine to IV amphotericin B deoxycholate, showed a final 6-month cure rate of 94% and 97%, respectively. In India, used for the treatment of visceral leishmaniasis. FDA approval is for patients 12 years of age and older, weighing at least 66 pounds, and not pregnant or breastfeeding. 

 Intramuscular pentamidine 

 Intramuscular pentamidine is effective against visceral leishmaniasis, but this drug has been associated with persistent diabetes and recurrent disease. Pentamidine is the drug of choice for the treatment of  guyanensis in French Guiana, where resistance is common. 

 Other agents 

 Ketoconazole, itraconazole, fluconazole, allopurinol and oral dapsone have been evaluated worldwide, but none are as effective as the pentavalent compounds of antimony. However, with their minimal side effect profile, these agents may be useful in speeding up the healing process in patients with cutaneous leishmaniasis who have not progressed to mucosal disease and are predisposed to self-absorption. Efficacy has been demonstrated against L (Viannia) panamensis in Panama and L major in Iran and Israel, while no effect has been observed against L tropica in India and Turkey. 

 Patients with leishmaniasis may present with concomitant systemic disease or local infection. Visceral leishmaniasis is a significant opportunistic infection associated with acquired immunodeficiency syndrome (AIDS), and patients co-infected with human immunodeficiency virus (HIV) may develop clinical manifestations. current clinic. Guidelines have been established for the prevention and treatment of opportunistic diseases in patients infected with HIV.  Pentamidine is the first-line agent for the treatment of cutaneous leishmaniasis except for L Mexicana (ketoconazole 600 mg orally per day for 28 days). Available antibiotic preparations include pentamidine isethionate (Pentium) and pentamidine methane sulfonate (Lomidine). 

 Relapsed patients 

 The nine relapsed patients did not differ from the cured patients in the following baseline characteristics. For relapsed patients, the mean values ​​are as follows: age, 36 years; extension of the spleen below the margin, 6.7 cm; parasite density, 2.1; the percentage of those who had received previous treatment, 67 per cent; and daily dose, 2.3 mg per kg. 

 The cure rate in patients who discontinued drug treatment prematurely. Of the nine patients in the miltefosine group who prematurely discontinued drug therapy, one withdrew from the study and 8 discontinued due to intolerance or continued treatment, they continue to be sick. Of these eight patients, four did not return during the six-month follow-up. Of the remaining 4 patients, 3 fully recovered: one discontinued treatment after 14 days due to the elevation