A policy for leishmaniasis with respect to the prevention and control of drug resistance


Bryceson, A; (2001) A policy for leishmaniasis with respect to the prevention and control of drug resistance. Tropical medicine & international health, 6 (11). pp. 928-34. ISSN 1360-2276

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Abstract

At the moment no country has a policy designed to control or prevent drug resistance in leishmaniasis. The risk of resistance is high in areas of anthroponotic visceral leishmaniasis, for example North Bihar, India, where the rate in some areas is 60%. Post-epidemic Sudan is also at risk. Zoonotic areas in which HIV co-infection is common could also be at risk as sandflies can become infected from co-infected individuals. Many factors determine the choice of drug for the treatment of visceral leishmaniasis, and drug resistance may not be the over-riding priority. In anthroponotic areas reduction in transmission through public health measures will be important, but the use of two drugs in combination should be seriously considered. Pharmacokinetic and other features of the drugs available, relevant to their use in combination are discussed and tentative suggestions made concerning trials of possible combinations. These include miltefosine plus paromomycin and allopurinol plus an azole. Lessons may be learnt from the experiences of similar problems in malaria, leprosy and tuberculosis. Guidelines are offered for the introduction of policies to use drugs in combination, which differ between anthroponotic and zoonotic areas of transmission.

Item Type: Article
Keywords: Antiprotozoal Agents/adverse effects/standards/*therapeutic use, Disease Management, Disease Outbreaks/prevention & control, *Drug Resistance, Drug Synergism, *Drug Therapy, Combination, *Health Policy, Human, Leishmaniasis/*drug therapy/epidemiology/prevention & control, World Health, Antiprotozoal Agents, adverse effects, standards, therapeutic use, Disease Management, Disease Outbreaks, prevention & control, Drug Resistance, Drug Synergism, Drug Therapy, Combination, Health Policy, Human, Leishmaniasis, drug therapy, epidemiology, prevention & control, World Health
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: Leishmaniasis Group
PubMed ID: 11703848
Web of Science ID: 172100000013
URI: http://researchonline.lshtm.ac.uk/id/eprint/17706

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