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Proper chemotherapy is pivotal in the management of visceral leishmaniasis (VL, also known as kala-azar); without an effective treatment this neglected parasitic disease is inevitably fatal [1]. Nevertheless, the few new and safer but more expensive treatment options that were developed in the past decade (i.e., liposomal amphotericin B and miltefosine) remain largely out of reach of the affected rural population who are most in need, mainly the poorest of the poor [2]–[4]. Miltefosine, an alkylphosphocholine drug, is an essential drug in the management of VL as it is the first effective oral treatment option with a reasonable safety profile [5]. Oral miltefosine allows the treatment of VL patients without an extended period of hospital admission and thus puts fewer demands on both patients and health services [6], [7]. Miltefosine is currently preferred for implementation in national VL elimination programmes [8], although the burden of high treatment costs incites the exploration of possibilities for a generic miltefosine product [9]. Unfortunately, the precarious position of VL patients was recently jeopardized as patients in Bangladesh were confronted with a new threat: the emergence of a new miltefosine product containing no active pharmaceutical ingredient [10], [11].

A Poor-Quality Generic Drug for the Treatment of Visceral Leishmaniasis: A Case Report and Appeal