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Antimicrobial Agents and Chemotherapy, January 2006, p. 73-79, Vol. 50, No. 1
0066-4804/06/$08.00+0     doi:10.1128/AAC.50.1.73-79.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

In Vitro and In Vivo Interactions between Miltefosine and Other Antileishmanial Drugs

Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

Received 9 August 2005/ Returned for modification 5 September 2005/ Accepted 13 October 2005

The interaction of miltefosine with amphotericin B, sodium stibogluconate, paromomycin, and sitamaquine was assessed in vitro and additionally for the first three combinations in vivo. In vitro interactions were indifferent for miltefosine combined with amphotericin B (mean sums of fractional inhibitory concentrations [mean FICs] ranging from 1.22 to 1.51 at the 50% effective concentration [EC₅₀] level and 1.08 to 1.38 at the EC₉₀ level), sitamaquine (mean FICs from 1.33 to 1.38 and 1.0 to 1.02, respectively), and paromomycin (mean FICs from 0.79 to 0.93 at the EC₅₀ and 0.77 to 1.35 at the EC₉₀ level). Some synergy was observed for miltefosine combined with sodium stibogluconate (mean FICs from 0.61 to 0.75 at EC₅₀ and 0.49 to 0.97 at EC₉₀). Different interactions were found in vivo, where the highest potentiation of miltefosine activity was achieved with amphotericin B (activity enhancement index [AEI] of up to 11.3). No significant interaction was observed when miltefosine was combined with sodium stibogluconate (AEI of up to 2.38). The potentiation of miltefosine in vivo was also achieved with the combination of miltefosine and paromomycin (AEI of up to 7.22).

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