Table 1. Drugs for the Treatment of Visceral Leishmaniasis [Download PDF]
|
|
Dose |
Duration (days) |
Route |
|
Proved efficacy and available |
|
|
|
|
Antimony |
20 mg/kg/day |
28 or > |
i.m., i.v. |
|
Amphotericin B |
1 mg/kg/day |
20 |
i.v. (slow) |
|
Liposomal amphotericin B |
3-4 mg/kg/day |
D 1-5 +10 |
i.v. |
|
Lipid associated amphotericin B |
2-3 mg/kd/day |
5 |
i.v.
|
|
Miltefosine |
<25 kg 50mg/d >25 kg 100-150 mg/d |
28 |
Oral |
|
Of proved efficacy but not (yet) available) |
|
|
|
|
Aminosidin1 |
16-20 mg/kg/day |
21-28 |
i.m. |
|
Efficacy less certain |
|
|
|
|
Pentamidine |
3-4 mg/kg/day |
15 inj. |
i.m., i.v. |
1Combination treatment advised
Table 2. Adverse Events During Antimony Treatment as Reported in Different Studies
|
Author |
Llanos-Cuentas113 |
|
Aronson18 |
Soto274 |
||
|
Country/ Year |
Peru |
|
1997 |
|
USA 1998 |
Colombia/Bolivia 2004 |
|
Disease/ Parasite |
MCL |
|
L.b. complex |
CL VL |
CL |
|
|
Treatment |
|
Sb |
Sb + |
A |
Sb Sb |
Gluc* Pent* SSG* |
|
Dose mg/kg/d Duration |
20/28 |
20/28 |
20/28 |
20/20 20/30 |
20/20 20/20 20/20 |
|
|
Number |
|
41 |
|
40 |
83 13 |
50 16 48 |
|
EVENT |
n |
% |
n |
% |
n (%) n (%) |
n (%) n (%) n (%) |
|
Headache |
32 |
78 |
34 |
85 |
19 (23) 2 (17) |
16 (32) 5 (31) 9 (19) |
|
Arthralgia |
32 |
78 |
29 |
72.4 |
49 (60) 7 (58) |
|
|
Myalgia |
31 |
75.6 |
24 |
60 |
45 (45) 6 (50) |
23(46) 9 (56) 14 (29) |
|
Abdominal Pain |
14 |
34.1 |
13 |
32.5 |
24 (29) 4 (33) |
8 (16) 4 (25) 2 (4) |
|
Anorexia |
9 |
22 |
12 |
30 |
20 (24) 2 (17) |
|
|
Haematologic Toxicity |
11 |
26.8 |
12 |
30 |
(44,of 96) |
11 (22) 3 (19) 5 (10) |
|
Hepatic Toxicity |
6 |
14.6 |
5 |
12.5 |
(>60) (>60) |
27 (54) 12 (75) 21(44) |
|
Renal Abnormality* |
9 |
22 |
8 |
20 |
|
|
|
Pancreatic toxicity |
|
|
|
≥ 84% ≥84% |
32 (64) 11 (69) 22 (46) |
|
|
ECG Abnormality |
|
not done |
|
20 p (21%) (of 96) |
19 (38) 5 (31) 16 (33) |
|
MCL: mucocutaneous leishmaniasis * Gluc: GlucantimeŽ
CL: cutaneous leishmaniasis * Pent: PentostamŽ
VL: visceral leishmaniasis * SSG: sodium stibogluconate, generic
Sb: pentavalent antimony
A: allopurinol
L.b. complex Leishmania ‑braziliensis complex;
* Serum creatinine at least 0.3 mg/1 higher than base line value
Table 3. Results of Treatment of Mucosal Leishmaniasis with Pentavalent Antimony Alone or Pentavalent Antimony plus Allopurinol in One Study113 .
|
|
severe disease |
moderate disease |
||
|
treatment |
Sb |
Sb + A |
Sb |
Sb + A |
|
number |
11 |
11 |
30 |
29 |
|
clinical cure |
2 |
0 |
21 (75%) |
14 (63.6%) |
|
failure |
8 (80%) |
10 (90.1%) |
7 |
8 |
|
withdrawn |
1 |
1 |
2 |
7 |
Sb: pentavalent antimony 20 mg/kg/d x 28 days
A: allopurinol 20 mg/kg/d in 4 doses x 28 days