Table 1.

Recommended treatment regimens for Old World CL (not ranked by preference).¹

Local therapy

L. major 15% PM/12% MBCL ointment b.i.d. for 20 days (A) Intralesional antimonials, 1 -- 5 mL per session plus cryotherapy (liquid nitrogen: --195_C), both every 3 -- 7 days (1 -- 5 sessions) (A) Thermotherapy, 1 -- 2 sessions with localized heat (50_C for 30 s) (A) Intralesional antimonials or cryotherapy independently, as above (D)

L. tropica, L. aethiopica* and L. infantum* 15% PM/12% MBCL ointment, as above (D) Intralesional antimonials plus cryotherapy, as above (D) Thermotherapy, as above (A) Intralesional antimonials, alone, as above (B) Cryotherapy, alone, as above (C)

Systemic therapy

L. major Fluconazole, 200 mg/day oral for 6 weeks (A) Sbv, 20 mg Sb5+/kg/day intramuscularly or intravenously for 10 -- 20 days (D) Sbv, 20 mg Sb5+/kg/day intramuscularly or intravenously plus pentoxifylline, 400 mg t.i.d. for 10 -- 20 days (A)

L. tropica and L. infantum* Sbv, 20 mg Sb5+/kg/day intramuscularly or intravenously for 10 -- 20 days (D) Sbv, 15 -- 20 mg Sb5+/kg/day intramuscularly or intravenously for 15 days plus oral allopurinol 20 mg/kg for 30 days, to treat leishmaniasis recidivans caused by L. tropica (C)

L. aethiopica Sbv 20 mg Sb5+/kg/day intramuscularly or intravenously plus PM, 15 mg (11 mg base)/kg/day intramuscularly for 60 days or longer to treat diffuse CL

^*Few data are available on therapy for CL caused by L. infantum and L. aethiopica.

^AEvidence obtained from at least one properly designed randomized controlled trial;

^Bevidence obtained from well-designed trials without randomization;

^Copinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees;

^Dexpert opinion without consistent or conclusive studies.