What is the recommended regimen for the treatment of visceral 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

Be alert for complications related to reticuloendothelial system failure. Patients may have bleeding or neutropenia leading to infectious conditions such as pneumonia or diarrhea. Transfusions may be necessary for severe bleeding or anemia. Antibiotics are indicated to treat intercurrent infectious conditions.

On the Indian subcontinent, the following treatment regimens are recommended for visceral leishmaniasis:

  • Liposomal amphotericin B alone, given as a single dose (currently recommended as the drug of choice by the Kala-Azar elimination programme of India)
  • Liposomal amphotericin B in a single dose, in combination with 7 days of oral miltefosine or 10 days of paromomycin
  • Miltefosine plus paromomycin for 10 days
  • Amphotericin B deoxycholate: 0.75-1 mg/kg/day via infusion, daily or on alternate days for 15-20 doses
  • Miltefosine orally for 28 days or paromomycin intramuscularly for 28 days
  • Pentavalent antimonials: 20 mg Sb5+/kg/day intramuscularly or intravenously for 30 days in areas where they remain effective: Bangladesh, Nepal, and the Indian states of Jharkhand, West Bengal, and Uttar Pradesh [13, 53]

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