Recent advances in development of amphotericin B formulations for the treatment of visceral leishmaniasis.

Amphotericin B (AmpB) is considered the first-line treatment for visceral leishmaniasis in areas in which resistance to antimony is prevalent. This review describes recent advances in clinically available and novel drug delivery systems of AmpB to treat visceral leishmaniasis. Over the past two decades, lipid-based AmpB formulations developed to tackle the toxicity of AmpB have been used clinically for the treatment of visceral leishmaniasis. Liposomal AmpB (AmBisome) has been the most successful lipid formulation, and recent clinical studies on visceral leishmaniasis have shown the potential of single-dose AmBisome treatment as well as its use in short course combinations with other antileishmanial drugs. Current research is focussed on the development of more stable and affordable nonlipid formulations of AmpB. Although a diverse range of nonlipid-based AmpB formulations have been evaluated, none have yet reached the clinic. Liposomal AmpB (AmBisome) has become a standard treatment, by intravenous infusion, for visceral leishmaniasis and the basis for new short course treatments. There have been extensive efforts to develop new AmpB formulations on the basis of polymers, lipids or physical aggregates of AmpB to replace the costly lipid-based formulations. However, no nonlipid-based AmpB delivery systems have yet reached the clinic.