Version May 2024
| Preferred therapy and duration | Alternative therapy | Other options/issues | |
| VL in previously immunocompetent patient | East Africa: Sodium stibogluconate* 20 mg/kg IV or IM daily PLUS paromomycin 15 mg/kg IM daily for 17 days¶[1,2] | East Africa: Liposomal amphotericin B 3 mg/kg IV daily alone for 10 days[3,4] or miltefosine◊ PLUS paromomycin 20 mg/kg IM daily for 14 days¶[5] | Nutritional support, treatment of hemorrhagic or infectious complications. Sodium stibogluconate* 20 mg/kg IV or IM daily for 28 days or amphotericin B lipid complex injection or amphotericin B deoxycholate (optimal regimen not established). |
| South Asia: Liposomal amphotericin B 3 mg/kg IV on days 1 to 5, 14, and 21Δ | South Asia: Miltefosine◊ for 28 days | ||
| Europe/Americas: Liposomal amphotericin B 3 mg/kg IV daily for 7 days[6] | Europe/Americas: Amphotericin B lipid complex injection or amphotericin B deoxycholate (optimal regimen not established) | ||
| HIV-VL coinfection | East Africa: Liposomal amphotericin B 5 mg/kg IV on days 1, 3, 5, 7, 9, and 11 PLUS miltefosine◊ for 28 days[7] | East Africa: Liposomal amphotericin B 5 mg/kg IV on days 1 to 5, 10, 17, and 24[7] | ART should be initiated or optimized. Alternative regimens for treatment failure in East Africa and South Asia: Sodium stibogluconate* 20 mg/kg IV or IM daily for 28 days or amphotericin B lipid complex injection (optimal regimen not established). |
| South Asia: Liposomal amphotericin B 5 mg/kg IV on days 1, 3, 5, 7, 9, and 11 PLUS miltefosine◊ for 14 days[7] | South Asia: Liposomal amphotericin B 5 mg/kg IV on days 1 to 4, 8, 10, 17, and 24[7] | ||
| Europe/Americas: Liposomal amphotericin B 3 mg/kg/day up to a total dose of 40 mg/kg[6] | Europe/Americas: Amphotericin B deoxycholate 0.7 mg/kg/day for 28 days, maximum dose 50 mg/day | ||
| Secondary prophylaxis§: | |||
| East Africa: Sodium stibogluconate* 20 mg/kg IV or IM every 4 weeks | ||
| South Asia: Amphotericin B deoxycholate 1 mg/kg IV every 3 to 4 weeks[7] | ||
| Europe/Americas: Amphotericin B deoxycholate 1 mg/kg IV every 3 to 4 weeks[6] | ||
| Post kala-azar dermal leishmaniasis (PKDL) | East Africa: Sodium stibogluconate* 20 mg/kg IV or IM daily for 30 to 60 days¥ | Liposomal amphotericin B (optimal regimen not established but most reports achieved total dose of ≥30 mg/kg) | |
| South Asia: Miltefosine◊ 2.5 mg/kg/day orally for 12 weeks (maximum dose 150 mg/day)‡ | |||
| Europe/Americas: Miltefosine◊ 2.5 mg/kg/day orally for 12 weeks (maximum dose 150 mg/day)‡ |
VL: visceral leishmaniasis; IV: intravenous; IM: intramuscular; ART: antiretroviral therapy.
* Not available in the United States or Canada. Consult local health agencies for availability.
¶ Parenteral paromomycin is not available in the United States.
Δ Shorter regimens that achieve 10 to 20 mg/kg total dose (for example, 10 mg/kg single dose, 10 mg/kg/day for 2 days, or 4 mg/kg/day for 5 days) also have high efficacy with low rates of adverse effects[9].
◊ Do not use in patients who are pregnant or breastfeeding. Miltefosine is available in 50 mg capsules. United States product labeling recommends 50 mg twice daily for patients weighing 30 to 44 kg and 50 mg 3 times daily for patients weighing ≥45 kg (maximum dose: 150 mg/day). Other sources may provide different dosing recommendations[7,10].
§ Secondary prophylaxis should be administered to all patients with HIV-VL coinfection. Continue until CD4 count is >350 cells/microL (or the HIV viral load is undetectable) for at least 6 months and there is no evidence of VL relapse[7].
¥ Conventional treatment for East African PKDL consists of sodium stibogluconate 20 mg/kg/day for 30 to 60 days, but data suggest sodium stibogluconate (30 mg/kg/day for a minimum of 17 days) plus paromomycin (15 mg sulphate/kg/day for 17 days) may have higher efficacy.[11]
‡ Stated regimen is first-line treatment for PKDL; however, increasing failure rates have been reported.[12,13]آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
