Table 3. The main drugs currently used for treatment of visceral leishmaniasis.

Drug	Regimen	Toxicity	Cost/coursea	Main issues
Pentavalent Antimonials	20 mg/Sb5+/kg iv or im daily for 28–30 days	Frequent, potentially severe; Pancreatitis; Cardio, nephro hepatotoxicity	Generic ∼$53 Branded $70	Length of treatment Painful injection Toxicity: high mortality in co-infected African Patients Resistance in India
Conventional Amphotericin B	0.75–1 mg/kg iv for 15–20 doses (daily or alternate days)	Frequent Infusion-related Reactions, Nephrotoxicity	Generic price: ∼$21	Lengthy hospitalisation (in-patient care) Need for slow iv infusion Toxicity Heat stability
Liposomal Amphotericin B	3–5 mg/kg/d iv up to total dose of 10–30 mg/kg Single dose (10 mg/kg) in India	Uncommon and mild; Nephrotoxicity (limited)	Preferential price: $280 (20 mg/kg total dose) Commercial price: ∼10×	Price Slow iv infusion Heat stability (<25°C) Single dose not effective in East Africa
Miltefosine	Orally daily over 28 days; dose according to age and body weight	Common, usually mild and transient; gastro-intestinal, Nephro + Hepatotoxicity Possibly teratogenic	Preferential price: ∼$74 Commercial price: ∼$150	Price Possibly teratogenic Potential for resistanceb Patient compliance Relatively limited efficacy data in East Africa
Paromomycin Sulphate	15 mg/kg im daily for 21 Days (Indian subcontinent)	Uncommon, Nephrotoxicity Ototoxicity Hepatotoxicity	∼$15	Efficacy variable between and within regions (less in Sudan) Resistance readily obtained in lab isolates

^aActual costs of the drugs, costs related to the logistics of storage and distribution are not taken into consideration.

^bDue to long half-life + low genetic barrier (resistance readily obtained in lab isolates).

iv: intravenous; im: intramuscular.