Leishmaniasis: treatment, drug resistance and emerging therapies

Introduction: Leishmaniasis is one of the most neglected tropical infectious diseases in the world. Emergence of drug resistance and toxicity and high cost of the available drugs with lack of new antileishmanial drugs highlight the need to search for newer molecules with antileishmanial activities. Areas covered: This article describes the currently available antileishmanial drugs and their risk of developing resistance and discusses newer therapies. These include oral lipid-based formulations of amphotericin B, use of different drug delivery systems, and quinolone derivatives - naphthoquinone, buparvaquone, etc. Expert opinion: There are only a handful of antileishmanial drugs, and even fewer in the pipeline. Guideline-based treatment, with proper selection of antileishmanial compound, should be practiced. Combination therapy should be used preferably to prevent or delay drug resistance. As most patients with PKDL (post-kala-azar dermal leishmaniasis) are asymptomatic, it is important that shorter regimens are developed, which will encourage patients to opt for complete treatment. Pharmaceutical industry and "not for profit' organizations should be encouraged to enhance the efforts in finding clinically effective antileishmanial drugs.