Leish treatment with amphotericin B

[Robert Davidson]

Q: What is the incidence of resistances to amphotericin B in humans?
>What do you think about the risk  for humans ( transmission of resistant
>stains )of treating dogs ( in europe) with this drug
> for humans?

A: There is good evidence that ampho B resistance occurs in some situations:

1. AIDS patients who have had conventional or liposomal amphotericin B
frequently relapse, and when they do, are unresponsive to any preparation
of amphotericin B. 
2. In Sudan, occasional  patients (HIV neg) have been unresponsive to
liposomal amphotericin B.
3. In dogs, very large doses of liposomal ampho B were required to cure
some animals - most were unresponsive or relapsed: see "Activity of
liposomal amphotericin B (AmBisome) in dogs naturally infected with
Leishmania infantum." Oliva-G; Gradoni-L; Ciaramella-P; De-Luna-R;
Cortese-L; Orsini-S; Davidson-RN; Persechino-A
	J-Antimicrob-Chemother. 1995 Dec; 36(6): 1013-9

While I don't think that using ampho B in a few dogs will be a big hazard
to humans, neither do I think ampho B will be successful in most dogs. They
do not regain specific antileishmanial cellular immunity after treatment -
and in this regard they are a "model" for the difficult situation in HIV
infected VL patients.
yours, RND

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Dr Robert N Davidson   (r.n.davidson at ic.ac.uk) 
Infection and Tropical Medicine
Northwick Park Hospital, Harrow HA1  3UJ
Tel ++ 44 181 869 2830
Fax ++ 44 181 869 2836
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