Leishmaniasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

• Treatment decisions should be individualized, with expert consultation.
• In general, all clinically manifest cases of visceral leishmaniasis and mucosal leishmaniasis should be treated, whereas not all cases of cutaneous leishmaniasis require treatment.
• The treatment approach depends in part on host and parasite factors.
• Some approaches/regimens are effective only against certain Leishmania species/strains and only in particular geographic regions.
• Even data from well-conducted clinical trials are not necessarily generalizable to other settings. Of particular note, data from the many clinical trials of therapy for visceral leishmaniasis in parts of India are not necessarily directly applicable to visceral leishmaniasis caused by L. donovani in other areas, to visceral leishmaniasis caused by other species, or to treatment of cutaneous and mucosal leishmaniasis.
• Special groups (such as young children, elderly persons, pregnant/lactating women, and persons who are immunocompromised or who have other comorbidities) may need different medications or dosage regimens.

Cutaneous Leishmaniasis

• Decisions about whether and how to treat should be individualized.
• The treatment approach depends in part on the Leishmania species/strain and the geographic area in which infection was acquired; the natural history of infection, the risk for mucosal dissemination/disease, and the drug susceptibilities in the pertinent setting; and the number, size, location, evolution, and other clinical characteristics of the patient's skin lesions.
• In general, the first sign of a therapeutic response to adequate treatment is decreasing induration (lesion flattening).
• The healing process for large, ulcerative lesions often continues after the end of therapy.
• Relapse (clinical reactivation) typically is noticed first at the margin of the lesion.

Indications

Therapy of cutaneous leishmaniasis may be indicated to:

• decrease the risk for mucosal dissemination/disease (particularly for New World species in the Viannia subgenus)
• accelerate healing of the skin lesions
• decrease the risk for relapse (clinical reactivation) of the skin lesions
• decrease the local morbidity caused by large or persistent skin lesions, particularly those on the face or ears or near joints
• decrease the reservoir of infection in geographic areas where infected persons (vs. non-human animals) serve as reservoir hosts (such as in Kabul, Afghanistan, and other Leishmania tropica-endemic areas, where transmission is anthroponotic)

Medical Therapy

▸ Click on the following categories to expand treatment regimens.

Cutaneous Leishmaniasis   ▸  Systemic Therapy (Parenteral)   ▸  Systemic Therapy (Oral)   ▸  Local Therapy

Systemic Therapy (Parenteral) Preferred Regimen ▸ Sodium stibogluconate 20 mg/kg IV/IM once daily for 10-20 days Alternative Regimen ▸ Liposomal amphotericin B† 3 mg/kg/day IV infusion for 6-10 days † Data supporting the use of amphotericin B for treatment of cutaneous (and mucosal) leishmaniasis are anecdotal; standard dosage regimens have not been established. Systemic Therapy (Oral) Preferred Regimen ▸ [[ Local Therapy Preferred Regimen ▸ [[

References

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