Table 1.
Systemic treatment (IV and oral) of leishmaniasis.
| Drug | Efficacy | Safety (Adverse Events [AE]) |
Ease of Use | Cost | Other Considerations | Regimen |
|---|---|---|---|---|---|---|
| Miltefosine | + Proven effect on VL, MCL, CL; not as effective for VL by L. infantum chagasi |
+ Only for >12 y; GI, nephrotoxicity, hepatoxicity |
+ Oral |
- | Expensive, 28 days (or more) duration | 30–44 kg, 50 mg bid for 28 d; ≥45 kg, 50 mg tid for 28 d |
| Azoles (fluconazole/ ketoconazole) |
- Anecdotal data |
+ GI symptoms, headache, hepatotoxicity |
+ Oral |
+ | Adults: 200 mg daily for 6 wk | |
| Allopurinol | - Generally, not effective |
+ GI symptoms |
+ Oral |
+ | Usually in combination with another drug |
Adults: 300 mg daily for 6 wk |
| Azithromycin | - Anecdotal data |
+ GI symptoms, arrhythmia (rare) |
+ Oral |
+ | Adults: 500 mg daily for 5–10 d | |
| Liposomal amphotericin B |
+ Proven effect on VL, MCL, CL |
+ Hypotension, nephrotoxicity |
- IV |
- | Requiring hospitalization | 3 mg/kg/day on days 1–5, 14, and 21(total dose 21 mg/kg) |
| Amphotericin B deoxycholate |
+ Proven effect on VL, MCL, CL |
- Hypotension, nephrotoxicity |
- IV |
- | Requiring hospitalization | 1 mg/kg per dose daily or every other day for a total of 15–20 doses |
| Pentavalent antimonial compounds |
+ Proven effect on VL, MCL, CL |
Pain at injection site (IM), pancreatitis, leucopenia, headache, lethargy, myalgia, arthralgia, diarrhea, nausea, vomiting, nephrotoxicity, and elevation of liver enzymes |
- IV/IM |
- | Requiring hospitalization | 20 mg/kg/day for 21–28 d |
Efficacy: + proven efficacy; - generally, not effective/scarce data. Safety: + mild-moderate AE; - severe AE. Ease of use: + easy use; - difficult. Cost: + affordable; - expensive.