黑热病后真皮利什曼病(PKDL)是一种重要的被忽视的热带病,这具有巨大的流行病学意义,是kala-azar的水库.复发和对治疗的耐药性以及缺乏选择的药物和共识治疗指南在PKDL的管理中构成了重大问题。本文的目的是回顾PKDL的可用治疗选择,特别强调它们的药效学,药物动力学,有效性,安全,耐受性,和成本因素。在多个数据库(PubMed,EMBASE,MEDLINE,和Cochrane)用于关键字(单独和组合)。MeSH以及非MeSH术语,如“Kala-azar,\"\"利什曼病\"和\"治疗,\"\"管理,\“\”葡萄糖酸钠锑,\"\"葡甲胺锑酸盐,\"\"两性霉素B,\"\"巴龙霉素,“米尔特福辛”被考虑在内。在576篇相关文章中,15个被认为与本审查有关。使用“牛津循证医学中心(OCEBM)”和“推荐分类强度”(SORT)评估了这些文章的证据水平和推荐等级。该综述包括15项研究。由于多次记录的治疗失败报告,不鼓励使用葡萄糖酸钠。脂质体两性霉素B正在成为一种有利的选择,由于其在有效性和安全性方面的优势。Miltesfosine是印度的首选药物,因为口服给药容易,毒性风险最小。单独的巴龙霉素在PKDL中无效;然而,发现与葡萄糖酸钠的联合治疗是安全有效的。两性霉素B和米替福辛的组合是极好的选择之一。与明矾沉淀的高压灭菌利什曼原虫(明矾/ALM)疫苗+卡介苗(BCG)相结合的免疫治疗已显示出可喜的结果。Kala-azar继续困扰着热带国家,而PKDL作为其水库正威胁着其消灭。随着药物如脂质体两性霉素B和米替福辛的可用性,除了免疫疗法的出现,治疗这种疾病的未来看起来很有希望。
Post-kala-azar dermal Leishmaniasis (PKDL) is one of the important neglected tropical diseases, which has a tremendous epidemiological significance, being the reservoir of kala-azar. Relapse and resistance to treatment along with the lack of a drug of choice and consensus treatment guideline pose a significant problem in the management of PKDL. The aim of this article was to
review the available therapeutic options for PKDL, with special emphasis on their pharmaco-dynamics, pharmaco-kinetics, effectiveness, safety, tolerability, and cost factor. A comprehensive English language literature search was done for therapeutic options in PKDL across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination). MeSH as well as non-MeSH terms such as \"Kala-azar,\" \"Leishmaniasis\" AND \"Treatment,\" \"Management,\" \"Antimony Sodium Gluconate,\" \"Meglumine Antimoniate,\" \"Amphotericin B,\" \"
Paromomycin,\" \"Miltefosine\" were taken into consideration. Among 576 relevant articles, 15 were deemed relevant to this
review. These articles were evaluated using \"Oxford Centre for Evidence-Based Medicine (OCEBM)\" AND \"strength of recommendation taxonomy\" (SORT) with respect to the level of evidence and grade of recommendation. The
review includes 15 studies. The use of sodium stibogluconate is being discouraged because of multiple documented reports of treatment failure. Liposomal amphotericin B is emerging as a favorable option, owing to its superiority in terms of effectiveness and safety profile. Miltesfosine is the drug of choice in India because of the ease of oral administration and minimal risk of toxicity. Isolated
Paromomycin alone is not effective in PKDL; however, combination therapy with sodium stibogluconate is found to be safe and effective. Combination of amphotericin B and miltefosine is one of the excellent options. Immunotherapy with combination of alum-precipitated autoclaved Leishmania major (Alum/ALM) vaccine + Bacille Calmette-Gu´erin (BCG) has shown promising results. Kala-azar continues to haunt the tropical countries and PKDL being its reservoir is threatening its elimination. With the availability of drugs such as liposomal amphotericin B and miltefosine, apart from the advent of immunotherapy, the future of treatment of this condition looks promising.