What is the drug therapy for leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Treatment is tailored to the individual, because leishmaniasis is caused by many species or subspecies of Leishmania.

Pharmacologic therapies include the following:

  • Pentavalent antimony (sodium stibogluconate or meglumine antimonate): Used in cutaneous leishmaniasis; not marketed in the United States, but available through the CDC under an Investigational New Drug (IND) protocol

  • Liposomal amphotericin B (AmBisome): Effective against pentavalent antimony ̶ resistant mucocutaneous disease and visceral leishmaniasis

  • Oral miltefosine (Impavido): Approved by the FDA in March 2014 for visceral leishmaniasis due to L donovani; cutaneous leishmaniasis due to L braziliensis, L guyanensis, and L panamensis; and mucosal leishmaniasis due to L braziliensis

  • Intramuscular pentamidine: Effective against visceral leishmaniasis but associated with persistent diabetes mellitus and disease recurrence

  • Orally administered ketoconazole, itraconazole, fluconazole, allopurinol, and dapsone: None is as effective as the pentavalent antimony compounds, but they may be useful in accelerating cure in patients with cutaneous leishmaniasis that does not progress to mucosal disease and tends to self-resolve

  • Topical paromomycin: Shown to be effective against cutaneous leishmaniasis caused by L major and L mexicana

  • Sitamaquine: Undergoing phase 3 trials


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