TREATMENT OF LEISHMANIASIS

Leishmaniasis is a protozoal disease caused by genus Leishmania and is transmitted by sand fly bite.

Leishmaniasis	Primary	Alternative
Cutaneous	Pentavalent antimony compound; Sodium stibugluconate OR meglumineantimoniate: Dose: 20mg/kg/day -20 days	Pentamidine: 2-3mg/kg IV or IM daily -4-7 days OR Miltefosine: 25mg/kg/day PO- 28 days
Mucosal	Pentavalent antimony compound; Sodium stibugluconate OR meglumineantimoniate: Dose: 20mg/kg/day -28 days OR Liposomal amphotericin B with total cumulative dose of 20-60 mg/kg OR conventional amphotericin B 0.5-1 mg/kg IV daily to total dose of 20-40 mg/kg	Miltefosine: 25mg/kg/day PO- 28 days
Visceral/Kala-Azar	Liposomal amphotericin B: 3mg/kg IV once daily at days: 1-5,14 and21 OR at days 1-5, and 10 OR 10mg/kg at days1 and2	Pentavalent antimony compound (high resistance in India and Meditarranean; Sodium stibugluconate OR meglumineantimoniate: Dose: 20mg/kg/day -28 days Miltefosine: 25mg/kg/day PO- 28 days Conventional amphotericin B 1 mg/kg IV daily – 20 days

 

Widespread misuse has led to the emergence of resistance in pentavalent antimony compounds in the hyper endemic areas (up to 40-50% cases). Therefore the drug of choice in these areas is now amphotericin B.

Dr Naima Fasih