Leishmaniasis medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 64: Line 64:
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Sodium stibogluconate]] 20 mg/kg IV/IM once daily for 10-20 days'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal amphotericin B]]† 3 mg/kg/day IV infusion for 6-10 days '''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | <small>† Data supporting the use of amphotericin B for treatment of cutaneous (and mucosal) leishmaniasis are anecdotal; standard dosage regimens have not been established.</small>
|-
|-
|}
|}

Revision as of 16:27, 29 December 2014

Leishmaniasis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Leishmaniasis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Leishmaniasis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Leishmaniasis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Leishmaniasis medical therapy

CDC on Leishmaniasis medical therapy

Leishmaniasis medical therapy in the news

Blogs on Leishmaniasis medical therapy

Directions to Hospitals Treating Leishmaniasis

Risk calculators and risk factors for Leishmaniasis medical therapy

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

Overview

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.[1]

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

  1. "CDC - Parasites - Leishmaniasis".


Template:WikiDoc Sources