Current situation and future of antileishmanial therapy in Colombia

Pentavalent antimonials are the first choice to treat leishmaniasis in Colombia. However, a 600% increase in the total dose has been necessary in order to maintain their efficacy. Cure rates varying between 93 and 25% can reflect differences in parasite susceptibility, but are more likely secondary to deficiencies in compliance with treatment guidelines. We review the current situation of efficacy and use of pentavalent antimony compounds, amphotericin B, pentamidine and miltefosine and attempt a projection for the next following years. To determine the real situation of response to antileishmanial drugs and to extend their useful life, the establishment of surveillance mechanisms to cover all factors involved is necessary. A sentinel site surveillance strategy to allow punctual observations in time, in specific geographical areas and in particular local situations, is proposed.