[Leish-l] SPAM-LOW: Re: miltefosine for diffuse leishmaniasis

[Jaime Soto]

Dear all,

 

I received some days ago a specific question regarding miltefosine use in
patients with renal impairment. I delay my answer asking to other people
because this is not an easy answer; this is the conclusion:

 

“Miltefosine is mildly nephrotoxic [Soto. CID 2004; 38:1266–72] in
leishmaniasis patients with normal renal function, Whether or not
miltefosine would further diminish renal function in renally-impaired
patients is not known. If renal function is already very low, however, a
further effect on renal function might not be seen. 

 

My personal view would be to not lower dosing because of a possible adverse
effect on the kidneys, specially because, in the specific case, full dose
could mean the difference between improving and failure.

 

Regards from Bolivia,

 

Jaime soto 

 

 

De: leish-l-bounces at lineu.icb.usp.br
[mailto:leish-l-bounces at lineu.icb.usp.br] En nombre de Carlos Costa
Enviado el: domingo, 10 de julio de 2011 05:44 p.m.
Para: Jennie Blackwell
CC: Leish-L
Asunto: SPAM-LOW: Re: [Leish-l] miltefosine for diffuse leishmaniasis

 

Hi Jennie,

 

Thanks for the drug information. Now, I have to check the permission for its
use in Brazil and how to justify its use to the public system in order to be
acquired by the government. Meanwhile, we are looking for miltefosine,
paramomycin, and alternative therapies.

 

But if the immunosuppression is species specific do you think that a general
stimulation would reverse it? Does anyone knows which is the mechanism
behind the DCL induced immunosuppression? Parasite or host or both? 

 

Cheers,

 

Carlos.

2011/7/7 Jennie Blackwell <jmb37 at cam.ac.uk>

Hello Carlos

 

My memory from late 80s was that these patients responded well to
interferon-gamma treatment. With all the moves to make drugs more affordable
for disease endemic countries, has it not been possible to consider this
option?

 

In psoriasis they use creams with Vitamin D. Has anyone ever tried this for
DCL?

 

I'm sure this is going to elicit a round of responses - but you know I'm not
a clinician so I would just be interested to know!

 

Cheers, Jennie 

Jenefer M. Blackwell

TICHR, CCHR, UWA

Phone: +61 8 94897910