Combination therapy with liposomal amphotericin b (ambisome), n-methylglucamine antimoniate (glucantime), and pentamidine isethionate in a refractory visceral leishmaniasis case

Gomes, Maria Antonia Ferreira; Medeiros, Lana Lira Cantidio de; Lobo, Fernanda Paula Dantas; Wanderley, Nathália Rayane Silva; Matos, Ana Paula Rodrigues; Jácome, Tácito do Nascimento; Monteiro, Maria Goretti Lins; Luz, Kléber Giovanni

doi:10.1590/0037-8682-0398-2017

Cited by 11 publications

(5 citation statements)

References 6 publications

(7 reference statements)

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“…This anti-Leishmania drug triple combination therapy is an empiric approach for VL treatment. Previously reported in children, 32 this is the first time that such a multidrug therapy has been used in an adult patient with VL. The patient responded excellently with no serious side effects and all symptoms completely disappeared.…”

Section: Discussionmentioning

confidence: 72%

“…31 The authors had had a previous experience of drug failure with L-AmB in a child presenting a refractory VL without apparent immunosuppressive condition who responded to this triple combination therapy. 32 Considering the possibility of parasite's resistance to amphotericin B, we decided to treat this patient with L-AmB, MA, and pentamidine, as previously reported. 32 When we combined the drugs for VL treatment, we could reduce the overall dose of each drug or, even, shorten the overall duration of the therapy.…”

Section: Discussionmentioning

confidence: 95%

“…32 Considering the possibility of parasite's resistance to amphotericin B, we decided to treat this patient with L-AmB, MA, and pentamidine, as previously reported. 32 When we combined the drugs for VL treatment, we could reduce the overall dose of each drug or, even, shorten the overall duration of the therapy. These potential advantages could mean more adherence to treatment with less cost.…”

Section: Discussionmentioning

confidence: 95%

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Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient

Vechi

Sousa²,

Cunha

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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In immunocompromised patients, visceral leishmaniasis (VL) can present with atypical clinical symptoms that include poor response to treatment. No optimal therapeutic regimen is available for such cases. In a splenectomized male patient, we observed a disseminated form of the disease in the liver, bone marrow, lymph nodes, and gastrointestinal tract. There was an apparent clinical improvement when he was initially treated with liposomal amphotericin B (L-AmB), but this was followed by a relapse involving severe clinical symptoms. He was finally treated successfully with a combination of L-AmB, meglumine antimoniate, and pentamidine isethionate. It is important to include asplenia as an immunosuppressive condition that induces exotic VL pathologies. In such cases, combination anti-Leishmania drug therapy should be considered.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

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Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient

Vechi

Sousa²,

Cunha

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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“…The cost‐effectiveness profile of the strategy combining MA and LAMB compared with MA alone deserves special attention because of its potential usefulness in the population of patients with worse prognosis e.g ., immunodeficiency or severe malnutrition . Further studies with longer time horizon and approaching other relevant outcomes, such as long‐term relapse and death, will be crucial to the decision‐making process on treatment indication for those poor prognosis subgroups involving the most challenging clinical cases .…”

Section: Discussionmentioning

confidence: 99%

Treatment for human visceral leishmaniasis: a cost‐effectiveness analysis for Brazil

Carvalho

Peixoto

Romero

et al. 2019

Tropical Med Int Health

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Objective To estimate the cost‐effectiveness of strategies for the treatment of VL in Brazil. Methods Cost‐effectiveness study comparing three therapeutic options: meglumine antimoniate (MA), liposomal amphotericin B (LAMB) and a combination of LAMB plus MA (LAMB plus MA), from public health system and societal perspectives. An analytical decision‐making model was used to compare strategies for the following outcomes: early therapeutic failure avoided at 30 days, days of hospitalisation avoided and VL cure at 180 days. The efficacy and safety parameters of the drugs came from a randomised, open‐label trial and the cost data came from a cost‐of‐illness study, both carried out in Brazil. Results For all outcomes analysed, the LAMB strategy was more effective. The MA strategy was inferior to the LAMB plus MA strategy for the outcomes early therapeutic failure avoided and cure. When only LAMB and MA were compared from a societal perspective, a cost of US$ 278.56 was estimated for each additional early therapeutic failure avoided, a cost of US$ 26.88 for each additional day of hospitalisation avoided and a cost of US$ 89.88 for each additional case of cured VL, for the LAMB strategy vs. MA. Conclusion In Brazil, the LAMB strategy proved to be cost‐effective for treating VL, considering a GDP per capita as the willingness‐to‐pay threshold, for all of the outcomes analysed in comparison to MA.

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“…Pentamidine, a broad‐spectrum anti‐infective agent, is often reserved for cases of therapeutic failure with antimonials and amphotericin B. However, its effectiveness in cutaneous leishmaniasis is questionable as success rates in Latin America seem to vary according to geographic region and parasite species [41–43] . It is worth mentioning that pentamidine application may trigger intense side effects including myalgia, nausea and hypotension [40] .…”

Section: Current Treatments For Leishmaniasismentioning

confidence: 99%

A “Golden Age” for the discovery of new antileishmanial agents: Current status of leishmanicidal gold complexes and prospective targets beyond the trypanothione system

et al. 2021

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Leishmaniasis is one of the most neglected diseases worldwide and is considered a serious public health issue. The current therapeutic options have several disadvantages that make the search for new therapeutics urgent. Gold compounds are emerging as promising candidates based on encouraging in vitro and limited in vivo results for several AuI and AuIII complexes. The antiparasitic mechanisms of these molecules remain only partially understood. However, a few studies have proposed the trypanothione redox system as a target, similar to the mammalian thioredoxin system, pointed out as the main target for several gold compounds with significant antitumor activity. In this review, we present the current status of the investigation and design of gold compounds directed at treating leishmaniasis. In addition, we explore potential targets in Leishmania parasites beyond the trypanothione system, taking into account previous studies and structure modulation performed for gold‐based compounds.

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Combination therapy with liposomal amphotericin b (ambisome), n-methylglucamine antimoniate (glucantime), and pentamidine isethionate in a refractory visceral leishmaniasis case

Cited by 11 publications

References 6 publications

Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient

Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient

Treatment for human visceral leishmaniasis: a cost‐effectiveness analysis for Brazil

A “Golden Age” for the discovery of new antileishmanial agents: Current status of leishmanicidal gold complexes and prospective targets beyond the trypanothione system

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