[Leish-l] Warning: Drugs for human leishmaniasis used to treat dogs

[Petersen, Christine]

Actually there is good evidence that antimonials provide decreased infectiousness after treatment of dogs:
See table 4, Miro et al Trends in Parasitology 2017.
We need similar studies using miltefosine and liposomal amphotericin to make conclusions, but I think the old idea that dogs do not get sterile cure so by treating them we put humans at a greater risk of infection with antimicrobial resistant drugs isn’t necessarily true. This is a place where veterinarians and medical doctors, public health professionals and entomologists (and others) should all come together to have a consensus.
With dog owners significantly bonded to their dogs globally, it is not ethically ok to assume that culling is the only viable approach, although depending on the location and finances, it might be.
Additional therapies including appropriate topical insecticides are critical to prevent transmission from any domestic reservoir to people (or other pets).  There is lots of evidence that dogs are not the only reservoir for L. infantum, and culling dogs in Brazil is definitely not preventing transmission of L. infantum.
There also might be a role for vaccination in decreasing transmission, but there is little to no data to confirm this possibility.
Christy Petersen, DVM, PhD
Dept. of Epidemiology
Univ. of Iowa

-----Original Message-----
From: leish-l-bounces at lineu.icb.usp.br <leish-l-bounces at lineu.icb.usp.br> On Behalf Of Kwang-Poo Chang
Sent: Sunday, November 10, 2019 11:07 AM
To: Rolando Oddone <roloddone at googlemail.com>
Cc: Leish-L <leish-l at lineu.icb.usp.br>; K-P Chang <changk2000 at yahoo.com>
Subject: Re: [Leish-l] Warning: Drugs for human leishmaniasis used to treat dogs

You are quite right.There has been no effective anti-leishmanial  period.
Under the circumstances, different countries develop their own policies best suited in their view for their own endemic areas. The problem is that Leishmania spp. do not recognize or do not respect borders and slip into Paraguay illegally without a visa. They are unstoppable even if you hire Donald Trump to build a wall. That is the unfortunate reality.\

KP



On Sat, Nov 9, 2019 at 2:38 AM Rolando Oddone <roloddone at googlemail.com>
wrote:

> Yes, Dr Kwang-Poo Chang. The position of health authorities and PAHO 
> officials (at least in Paraguay) is to restrict the use of these drugs 
> only for human cases. The reason is obvious. As the Leishmania are not 
> totally killed by these drugs during treatment, they are creating 
> resistance against these same drugs. Similar situation ocurred in 
> India during the 1990's, with indiscriminate use of antimonials in 
> humans. In some regions of India, nearly 50% of VL cases (caused by L. 
> donovani) were found resistant to SbV, therefore WHO speeded up the 
> use of Miltefosine as alternative drug. But in our case, Miltefosine 
> is not as useful as in India. It can cure VL cases (in Paraguay caused 
> by L. infantum) but they easily relapse.
>
> The conclusions of the last WorldLeish in Spain were clear: there are 
> no new drugs for leishmaniasis. If we are creating resistance of 
> Leishmania against SbV, we will have very few options for all human 
> cases. But if dogs do not use antimonials, they can be treated by 
> other drugs, as far as I understand.
>
>
> Rolando Oddone
>
>
> El mar., 5 de nov. de 2019 a la(s) 17:13, Kwang-Poo Chang (
> kwangpoo.chang at rosalindfranklin.edu) escribió:
>
>> Dear Rolando,
>>
>> Both drugs you mentioned have been used by veterinarians elsewhere 
>> for treating canine leishmaniasis, although neither has been shown to 
>> cure the disease. According to my colleagues in Naples, Italy, the 
>> diseased dogs responded positively to the treatment when used at high 
>> dosage initially, as indicated by a reduction of LD loads and 
>> alleviation of clinical symptoms, but ~50% of them died of flare-ups 
>> eventually. Your concern seems to be a regulatory issue of 
>> restricting the use of these drugs only for human cases in Paraguy ?
>>
>> Laura Manna is a DVM in Naples who has been trying our 
>> photodynamically inactivated Leishmaina as non-viable whole-cell 
>> vaccines for immunotherapy of canine leishmaniasis after initial 
>> chemotherapy with evidence of some effectiveness. Let me know, should 
>> you or your colleagues are interested in this ?
>>
>> KP
>>
>> Kwang Poo Chang, PhD
>> Professor of Microbiology/Immunology
>> Chicago Medical School/RFUMS
>> N Chicago, IL 60064, USA
>>
>> On Fri, Nov 1, 2019 at 4:40 PM Rolando Oddone 
>> <roloddone at googlemail.com>
>> wrote:
>>
>>> In Paraguay we have growing proliferation of dogs with leishmaniasis (L.
>>> infantum) since the 1990s.
>>> But dog owners with leishmaniasis are increasingly reluctant to 
>>> sacrifice their animals. In recent years Glucantime and Milteforan 
>>> are entering the country smuggled (apparently they come from France and Spain), for "free"
>>> use in dogs. These medications are currently being used 
>>> indiscriminately by veterinarians who, for profit, take advantage of 
>>> the need that people have to want to preserve the lives of their 
>>> pets.
>>> Under this scenario, hundreds of dogs have already been treated with 
>>> these drugs, perhaps a thousand in a few years, and the magnitude of 
>>> the problem will increase.
>>> However, the authorities of the Ministry of Health do not take any 
>>> measures, despite the existence of recommendations that these drugs 
>>> are exclusively for human use.
>>> The purpose of this sharing is, dear colleagues, that you express 
>>> your position regarding this situation, at least in this way, and 
>>> what would be the impact this could have at the international level. 
>>> Your joint voice will be better heard than the simple complaint I 
>>> may make.
>>>
>>>
>>> Rolando Oddone
>>> IICS-UNA
>>> Paraguay
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>>
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