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Miltefosine Susceptibility and Resistance in Leishmania: From the Laboratory to the Field
Adriano C. Coelho
Miltefosine is the first effective oral drug used in the chemotherapy of leishmaniasis. The drug is more effective than pentavalent antimonials that are still considered as the drug of choice for treatment of leishmaniasis in several endemic regions. Efficacy rates of miltefosine against visceral leishmaniasis are up to 95%, while against cutaneous leishmaniasis the rates vary between 53% and 91% depending on the species of the parasite and the endemic region. Recent reports have described an increased number of relapses in miltefosine-treated patients. This review describes the main findings associated with miltefosine susceptibility and resistance in Leishmania: two important factors involved in efficacy and failure in leishmaniasis treatment using this drug.