Evaluating drug resistance in visceral leishmaniasis: the challenges

摘要: For decades antimonials were the drugs of choice for treatment visceral leishmaniasis (VL), but recent emergence resistance has made them redundant as first-line therapy in endemic VL region Indian subcontinent. The application other been limited due to adverse effects, perceived high cost, need parenteral administration and increasing rate failures. Liposomal amphotericin B (AmB) miltefosine (MIL) have positioned effective treatments; however, number monotherapy MIL-failures increased after a decade use. Since no validated molecular markers are yet available, monitoring surveillance changes drug sensitivity still depends on standard phenotypic vitro promastigote or amastigote susceptibility assays. Clinical isolates displaying defined MIL- AmB-resistance fairly scarce fundamental applied research mechanisms dynamics remains largely dependent laboratory-generated resistant strains. This review addresses various challenges associated with -resistance VL, particular emphasis strains, model selection standardization procedures specific read-out parameters well-defined threshold criteria. latter essential support systems safeguard currently available antileishmanial drugs.