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Miltefosine an alkylphospholipid was registered in India for the treatment of visceral leishmaniasis (kala-azar) in 2002. The identification of miltefosine was an important therapeutic advance because it is the first effective oral agent for treating kala-azar including infection that is resistant to conventional therapy with pentavalent antimony and it has opened the door to outpatient management. However these clinical advances are being undermined and action is required. India carries approximately 50% of the world’s burden of kala-azar. Ninety per cent of cases of kala-azar in India occur in people living in poverty in rural Bihar State where daily family income is approximately US$ 1; infection there remains epidemic and transmission (anthroponotic) is high. Bihar is also the only endemic region where large-scale resistance probably the result of years of suboptimal treatment has ended the usefulness of antimony treatment Thus approximately 45% of the world’s kala-azar patients are in a precarious position. (excerpt)

Availability of miltefosine for the treatment of kala-azar in India.