{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:55:50Z","timestamp":1790844950035,"version":"4.1.0"},"reference-count":68,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T00:00:00Z","timestamp":1550534400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Meglumine antimoniate (<jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>; Glucantime\u00ae), the 80\u2010year\u2010old first\u2010line systemic treatment for all forms of American tegumentary leishmaniasis (<jats:styled-content style=\"fixed-case\">ATL<\/jats:styled-content>) caused by <jats:italic>Leishmania (Viannia) braziliensis<\/jats:italic>,<jats:italic> Leishmania (Viannia) guyanensis<\/jats:italic> and <jats:italic>Leishmania<\/jats:italic> (<jats:italic>Leishmania<\/jats:italic>) <jats:italic>amazonensis<\/jats:italic>, is highly toxic, presents adverse side\u2010effects and may not attain clinical and parasitological cure. This critical review examines the necessity for intramuscular\/intravenous administration of <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>, the alternatives to this approach, and the possibilities of developing affordable, accessible and non\u2010toxic drugs or new delivery methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>PubMed searches were performed using the terms \u2018cutaneous leishmaniasis\u2019 or \u2018American tegumentary leishmaniasis\u2019 in combination with \u2018meglumine antimoniate\u2019 or \u2018<jats:italic>N<\/jats:italic>\u2013methyl glucamine\u2019 or \u2018drug repositioning\u2019 or \u2018nanotechnology\u2019. Searches covered a period of 20\u00a0years of peer reviewed journals and technical bulletins. We explored the mode of action, pharmacokinetics, toxicity and efficacy of <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>, evaluated the progress of <jats:styled-content style=\"fixed-case\">ATL<\/jats:styled-content> therapy in Brazil, and examined the potential of drug repositioning and nanotechnology in accelerating the introduction and\/or optimisation of an alternative treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The evidence suggests that <jats:styled-content style=\"fixed-case\">ATL<\/jats:styled-content> therapy will continue to rely on systemic <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content> in the foreseeable future even though an intralesional subcutaneous route has evolved over the last 10\u00a0years. The chances of developing a novel drug for <jats:styled-content style=\"fixed-case\">ATL<\/jats:styled-content> or a new mode of delivery of <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content> are low. While <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content> nanocarriers afford a promising approach, this technology is still in its infancy. A more immediate solution would be the production of a bioequivalent of miltefosine, an efficacious oral agent no longer protected by patent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Development of a contemporary treatment requires governmental commitment in bringing together private and public sectors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13210","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T13:16:34Z","timestamp":1548422194000},"page":"380-391","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["American tegumentary leishmaniasis in Brazil: a critical review of the current therapeutic approach with systemic meglumine antimoniate and short\u2010term possibilities for an alternative treatment"],"prefix":"10.1111","volume":"24","author":[{"given":"S\u00edlvia H.","family":"Carvalho","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Doen\u00e7as Infecciosas e Parasit\u00e1rias Hospital Eduardo de Menezes Funda\u00e7\u00e3o Hospitalar do Estado de Minas Gerais  Belo Horizonte, Minas Gerais Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Fr\u00e9zard","sequence":"additional","affiliation":[{"name":"Departamento de Fisiologia e Biof\u00edsica Instituto de Ci\u00eancias Biol\u00f3gicas Universidade Federal de Minas Gerais Belo Horizonte, Minas Gerais Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neila P.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Departamento do Medicamento Faculdade de Farm\u00e1cia Universidade Federal da Bahia Salvador, Bahia Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre S.","family":"Moura","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Universidade Jos\u00e9 do Ros\u00e1rio Vellano\u2010Unifenas Belo Horizonte, Minas Gerais Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucin\u00e9ia M. 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