Antimicrobial agents: Edited by Monica A. Slavin, Simon Croft and Deenan PillayDrug combinations for visceral leishmaniasisOlliaro, Piero La,b Author Information aUNICEF/UNPD/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland bThe Centre for Tropical Medicine, Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK Correspondence to Piero L. Olliaro, UNICEF/UNPD/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland Tel: +41 22 791 3734; fax: +41 22 791 4854; e-mail: [email protected] Current Opinion in Infectious Diseases: December 2010 - Volume 23 - Issue 6 - p 595-602 doi: 10.1097/QCO.0b013e32833fca9d Buy Metrics Abstract Purpose of review Several attempts have been made to combine drugs for treating visceral leishmaniasis, but only recently have effective drugs become available and combinations been tested systematically. Recent findings Sequential treatments with liposomal amphotericin B followed by miltefosine or paromomycin (as short as 7 days), as well as the concomitant administration of miltefosine and paromomycin (for 10 days) are very effective in India (>95%). Sodium stibogluconate plus paromomycin for 17 days is more than 90% effective in East Africa. The shortened combination regimens are cost-effective in India. No combination has been tested so far in Brazil, Nepal and Bangladesh, although studies may be expected in the near future. No cost-effectiveness analysis has been done as yet outside India. Summary There is evidence of high efficacy and benefits with sequential and co-administration treatments in India. More studies are needed in other endemic areas. Introducing combinations and scaling up their use will be challenging. Experience acquired with malaria may be useful. Proper monitoring of use and effects (efficacy and safety) will be required. Currently there are no options for fixed-dose combination treatments for leishmaniasis. © 2010 Lippincott Williams & Wilkins, Inc.