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Chemotherapeutic Options with Leishmanicidal/Leishmaniostatic Effects

Chemotherapeutic Options with Leishmanicidal/Leishmaniostatic Effects

Drug and Dose

Mechanism of Action

Duration of Treatment

Common Side Effects

Time to Relapse/Recrudescence

Drug Resistance

Meglumine antimoniate*

(50 mg/kg twice daily SC or 100 mg/kg/day)

Inhibition of parasite phosphofructokinase metabolism

4-6 weeks

Local pain at site of injection, pancreatitis, nephrotoxicity

6-12 months

Reported

Miltefosine

(2 mg/kg daily)

Impairment of signaling pathways and cell membrane synthesis

4 weeks

Anorexia, vomiting, diarrhea

4-6 months

Not reported

Paromomycin*

(4 mg/kg SC)

Interference with mitochondrial pathway

3 weeks

Nephrotoxicity, ototoxicity

3-4 months

Not reported

Allopurinol

(10 mg/kg, PO, twice daily)

Interference with purine metabolism

6-24 months

Xanthinuria, urolithiasis, renal mineralization

Not well documented

Reported

Meglumine antimoniate*

(50 mg/kg,SC, twice daily or 100 mg/kg daily) +

allopurinol (10 mg/kg, PO, twice daily)

Inhibition of parasite phosphofructokinase metabolism and interference with purine metabolism

4 weeks (meglumine antimoniate) and 6-12 months (allopurinol)

Local pain at site of injection, pancreatitis, nephrotoxicity; xanthinuria, urolithiasis, renal mineralization

Not reported

Not reported

Miltefosine (2 mg/kg daily) +

allopurinol (10 mg/kg, PO, twice daily)

Impairment of signaling pathways and cell membrane synthesis and interference with purine metabolism

4 weeks (miltefosine) and 6-12 months (allopurinol)

Anorexia, vomiting, diarrhea, xanthinuria, urolithiasis, renal mineralization

Not reported

Not reported

Marbofloxacin (2 mg/kg daily)

Inhibition of DNA gyrase

4 weeks

Not reported

3-6 months

Not reported

Liposomal amphotericin B (3 mg/kg, IV, every 2 days)

Inhibition of cholesterol incorporation into cell membrane.

To total of 21 mg/kg over 2-3 weeks as tolerated

Diarrhea, vomiting, nephrotoxicity

Not reported

Not reported

*not commercially available in the USA. Adapted from Miro et al: Novel Areas for Prevention and Control of Canine Leishmaniosis. Trends Parasitol. 2017; 33(9)718-730.