Before the start of the study we expected referral of

Before the start of the study, we expected referral of up to 3% visceral leishmaniasis cases to the tertiary hospital for management of eventual complications. However, no referral was necessary because all adverse events were mild. Incidence of adverse events was about 47% during treatment and 63% within 2 h after treatment and in all cases were manageable with simple intervention including oral rehydration solution for hypotension or vomiting and antipyretics for fever and rigor. Furthermore, four pregnancies occurred after of treatment during the follow-up period. Pagliano and colleagues noted in their observational study that NVP-TAE684 structure liposomal amphotericin B for visceral leishmaniasis during pregnancy was safe and effective for mother and fetus. Firm conclusions about safety and efficacy during pregnancy and for the fetus cannot be made on the basis of our study, but our findings are encouraging and a long-term follow-up is planned. A potential question for implementation of liposomal amphotericin B is the risk of resistance. However, when used as a single dose, the risk of resistance is very low. Lachaud and colleagues showed no emergence of leishmania resistance to liposomal amphotericin B even after repeated multidose treatments or single-dose prophylaxis use in immunosuppressed patients with visceral leishmaniasis. Also, no guarantee exists smog any treatment combination is safe from resistance: resistance to combinations can be selected for in vitro over long periods. We suggest that combination therapies could be considered once the elimination target has been reached with single-dose liposomal amphotericin B. Contributors Conflicts of interest
Acknowledgments