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Table 1 Currently available anti-leishmanial drugs for treatment of VL: product name, cure rate, mode of action on parasite, advantages and limitations

From: Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective

S.N. Drugs Marketing authotization and commercial product Cure rate Mechanism of action Advantages Limitations
1 Pentavalent antimonials Albert David, India (generic SSG); Wellcome (Pentostam); Sanofi Aventis (Glucantime) 39–95 % depending on geographical condition (50 % in Bihar) Act as prodrug, inhibit trypanothione reductase, increase the ROS Low cost and easy available Parasite resistance especially in India, cardiotoxic, 30 day iv/im treatment in hospital, painful injections
Inhibit macromolecular biosynthesis in amastigotes
2 Amphotericin B Life care, India >98 % in all regions Form complexes with sterols mainly ergosterols of parasite membrane leading to increase permeability resulting in cell death High efficacy, 1st line treatment in case of antimonial resistance Dose-limiting renal toxicity, 15–30 day slow iv infusion treatment over 4–6h in hospital, hypokalaemia
(Fungitericin); Bristol –Myers (Fungisone)
3 Liposomal amphotericin B Gilead (AmBisome); >98 % Targeted delivery of drug to infected macrophages and kill the parasites as AmB Highest therapeutic index of available VL drugs, No need of hospitalization, substantially less nephro-toxic than AmB Expensive, requirement of cool chain temperature maintainance
Lifecare Innovation (Fungisome); Bharat Serum and Vaccine (Amphomul);
Sequus Pharmaceuticals (Amphocil);
ENZON Pharmaceuticals (Abelcet);
Lifecare Innovation (Kalsome)
4 Miltefosine Paladin Labs (Impavido) 94–97 % Modulate cell surface receptors and inositol metabolism of parasites, and cell death is mediated by apoptosis, Inhibit the cytochrome C oxidase Oral drug, Safe in HIV-VL co-infection Teratogenic in experimental animals, originally developed as an anti- cancer drug, expensive, GI toxicity, hepato- & renaltoxicity in phase-4
5 Paromomycin Gland Pharma/iOWH 94 % (India) Binds to 30S ribosomal subunit and interfere with protein biosynthesis, decrease the membrane potential of parasite Cheapest drug An aminoglycoside, therefore nephro- and ototoxicity possible, but have not been reported in VL patients, although reversible high tone audiometric shift may occasionally occur during treatment
6 Pentamidine Sanofi Aventis (Pentacarinat) 70–80 % Inhibit mitochondrial topoisomerase II and inhibit the transcription process Effective in combination therapy Gastointestinal adverse effect, hypotension, diabetes mellitus