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| Drugs | Advantages | Disadvantages | Resistance | Price | Comment |
|
Pentavalent antimonials
[1, 10–20] | Easily availability and low cost | Quality control; length of treatment; painful injection; toxicity; resistance in India | Common (>65% in Bihar, India) | $50–198 | First line drugs but with high incidences of resistance; variable response in different species that cause CL |
|
Amphotericin B
[1, 15, 16, 21–23, 40] | Primary resistance is unknown | Need for slow intravenous infusion; dose-limiting nephrotoxicity; heat instability | Laboratory strains | ~$21–100 | Severe toxicity; need for prolonged hospitalization; first-line drug for VL in India, where there is antimonial resistance |
|
Liposomal amphotericin B
[22, 23, 55–58] | Highly effective; low toxicity | Price; need for slow intravenous infusion; heat stability (needs to be stored below 25°C) | Not documented | $280–3000 | High cost |
|
Miltefosine
[1, 16, 30–32, 45, 48, 49] | Effective and safe | Price; possibly teratogenic; potential for resistance (half-life); poor patient compliance | Laboratory strains | $70–150 | Effective orally but its long half-life may encourage emergence of resistance on prolonged use; effective for VL and against some species that cause CL; contraindicated in pregnancy as found to be teratogenic in rats |
|
Paromomycin
[1, 27–29, 45] | Effective, well tolerated, and relatively cheap | Efficacy varies between and within regions; potential for resistance | Laboratory strains | $10–15 | Low cost; lack of efficacy in East Africa; topical formulation available for CL |
|
Pentamidine
[1, 16, 20, 24–26] | Short-time course | Efficacy varies between Leishmania species | Not documented | — | For specific forms of CL in South America only; first line of treatment of CL in French Guiana |
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