Susceptibility of clinical strains of Leishmania to pentavalent antimony and miltefosine: challenges and opportunities

Introduction Passive case detection and treatment constitute the principal and often the sole measure of control for dermal leishmaniasis in Central and South America yet pentavalent antimonials, the first line therapy, are often ineffective. Treatment failure is frequent and concerning in the management of cutaneous leishmaniasis in South America. Overall non-response is of the order of 24% based on a recent metaanalysis (Tuon, et al., 2008). Although therapeutic response is multifactorial, treatment with Glucantime® has been shown to select antimony (Sbv)-tolerant/resistant parasites and drug resistance to contribute to treatment failure in some patients (Rojas, et al., 2006).