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Animal Welfare in Greece:

 There are several treatments of Leishmaniasis currently available and depending on your geographical location, your vet may favour one treatment above others. Currently there is no cure, but the disease can be brought under control and the viral counts even reduced to levels that can be considered to be inactive. However the possibility of a relapse is always there, which is why the animal in question should be tested twice yearly and treatment must be resumed if the viral counts increase.

Below is a table of the most commonly acknowledged forms of treatment currently available. They can be divided into Leishmaniacides which actually lower viral counts and Leishmanaistatic treatments that only halt or slow the progress of the disease. Of the medications mentioned below, only Allopurinol is Leishmaniastatic.



N-methylglucamine (Glucantime®) has been in the past and is still, the most widely used treatment. It is the only drug from this group available in Europe. It has been demonstrated that 80% of the drug is eliminated by the kidney nine hours after administration. A recurrence of clinical signs or a rise in antibody levels means that treatment must be recommenced. This is often necessary six months after the first treatment. If this rule is not followed, there are usually relapses within a year.

Advantages and Disadvantages:
This treatment if applied as monotherapy for a long time is expensive for the owner. Daily injections can be painful for the dog. Intramuscular injections have to be rejected as there is a risk of pain, fibrosis and abcess. The side effects of treatment are usually benign (muscle and joint pain, hyperthermia, shivering). Severe side effects are uncommon (nephritis, hepatitis, neuritis, haematological disorders). Nevertheless, if seen, these signs justify the cessation of medication or a modification of dose in cases of renal insufficiency. The dog must first be tested for liver and kidney health before starting this treatment as it is contraindicated when there is renal insufficiency to start with.

Allopurinol (Zyloric® or Allopurinol-GNR) is used in human and veterinary medicine to prevent the formation of urate calculi. Its use as antileishmanial drug is more recent than the use of antimonials. Allopurinol is an oral purine analogue which disturbs the synthesis of proteins by leishmania. The daily dose is 20-30 mg/kg for an indefinite period of time (lifetime administration is sometimes advised). Most  veterinarians start treatment with a combination of allopurinol and meglumine antimoniate. Some prefer to continue with this combination, others with Allopurinol alone.

Advantages and Disadvantages:
Long term treatment with allopurinol is not expensive. Oral administration makes it an easy treatment for the owner. It is a relatively non toxic drug. The only reported side effect is theo ccurrence of xanthine uroliths. For all these reasons, more and more veterinarians use Allopurinol as a single treatment. However since it has no direct effect on lowering leishmania viral counts (thus increasing the risk of spreading the disease) it's prescription as a single treatment is controversial. In Greece it is the most commonly prescribed treatment for pet owners who do not wish to pay for, or cannot afford more expensive treatments.

Miltefosine (Milteforan®), an alkylphosphocholine, was developed as an anti-tumour agent. It is currently the gold standard for treating Canine leishmaniasis. The drug is administered orally for 28 days. Clinical tests have shown that 82.7% of the dogs treated with the miltefosine drug showed an equal or higher treatment efficacy than other antileishmanial drugs. According to clinical scores, the treatment demonstrated a significant time-dependent therapeutic effect resulting in a 61.2% mean reduction on day 56. Hematologic and biochemical analyses showed improvements in most of the parameters examined, supporting the observed clinical efficacy of the drug.*

Advantages and disadvantages:
The drug is a liquid administered via orally making treatment easy compared to painful injections. There is a high clinical cure rate with viral counts shown to be drastically affected. During the trial, the adverse reactions probably associated with the drug treatment were observed in 11.7% of the dogs. However, they were not serious. The most frequent one was vomiting, which was transient, self-limiting, and reversible. Furthermore, the drug has been shown not have adverse effects on the liver and kidneys, thus making it possible to prescribe to dogs with renal insufficiency and avoiding the danger of this for dogs that do not have this at the start of treatment. However Milteforan is expensive compared to other treatments which is why some vets prefer to prescribe this in conjunction with inexpensive Allopurinol. Twice yearly tests are still required as the virus is not completely eradicated from the system. In the case of a relapse the treatment is repeated. Milteforan is available and prescribed in Greece by veterinarians.

*http://www.springerlink.com/content/y80752x37uv4v633/

Marbofloxacin (Marbocyl®) from the quinolines group of drugs, is a third generation synthesis fluoroquinolone, developed only for the veterinary use. In vitro, marbofloxacin showed a direct and indirect leishmanicidal activity on Leishmania infantum. The results obtained show that Marbocyl® P, administered at 2 mg/kg once per day for 28 days, proves efficacious to treat canine leishmaniasis: clinical improvement (regression of skin lesions, lymphadenopathy, onychogryphosis and splenomegaly) and significant decrease in the amastigote number. *

Advantages and disadvantages:
Marbocyl is also expensive and as yet there are no clinical trials that demonstrate quantified cure rate. However it is the only drug till now shown to have a direct effect killing the virus in vitro. Strangely enough it seems to be only commonly prescribed in Spain. It is available in Greece as a treatment for other illnesses but the vets here do not seem to have heard of this use of the drug. Posts by veterinarians and pet owners alike, in forums dealing with the disease in Spain have claimed very high levels of efficiency, ranging from 60-80% success rate. The side effects are also mild and it is not considered harmful to the livers and kidneys. It should be considered a very viable alternative in treating this disease.

*http://www.vetoquinol.at/presse_dtl.php?id=7&PHPSESSID=a89ogjiot69qha61qv0iq8no71

Supportive treatments are special diets and formula dog food for dogs with this disease and vitamin supplements of which Vetimune has been recommended especially for dogs showing signs of anemia and general poor health. This is a food complement for dogs and cats based on an oat extract rich in beta-glucanes, baicalin from an extract of Scutellaria baicalensis, fresh royal jelly, Panax ginseng extract rich in ginsenosides and polysaccharides, Coenzyme Q10, Vitamins B1, B2, B3, B5, B6 and B12, folic acid, bi
otin and selenium. *

*http://www.fdg-farmadiet.com/index.php?option=com_content&task=blogcategory&id=65&Itemid=5&lang=en