Version June 2024
| Drug | Dose | |
| Local therapy | ||
| Pentavalent antimonials* | Sodium stibogluconate | 0.5 to 2 mL of 100 mg/mL pentavalent antimony (Sb5+) intralesionally every 7 days until healed (treat up to 3 weeks) |
| Meglumine antimoniate¶ | 0.5 to 2 mL of 81 mg/mL pentavalent antimony (Sb5+) intralesionally every 7 days until healed (treat up to 3 weeks) | |
| ParomomycinΔ | Paromomycin ointment | Apply topically to lesions twice daily for 10 days, rest for 10 days, then reapply for 10 days |
| Paromomycin cream (15%) | Apply topically to lesions once daily for 20 days | |
| Oral systemic therapy | ||
| Azoles | Fluconazole | 200 to 400 mg orally once daily for 6 weeks |
| Ketoconazole | 600 mg orally once daily for 28 days | |
| Miltefosine | Miltefosine◊ | 2.5 mg/kg (maximum 150 mg) orally in three divided doses for 28 days; if weight is 30 to 44 kg, use 50 mg orally twice daily |
| Parenteral systemic therapy | ||
| Pentavalent antimonials* | Sodium stibogluconate | 20 mg SbV/kg/day intravenously or intramuscularly for 10 to 20 days§ |
| Meglumine antimoniate | 20 mg SbV/kg/day intravenously or intramuscularly for 10 to 20 days§ | |
| Amphotericin | Amphotericin B deoxycholate | 0.5 to 1 mg/kg intravenously dosed daily or every other day for a cumulative total dose of 15 to 30 mg/kg |
| Liposomal amphotericin B (AmBisome) | 3 mg/kg intravenously daily for 6 to 7 doses | |
| Pentamidine | Pentamidine isethionate | 7 mg/kg pentamidine salt intravenously or intramuscularly weekly for 3 doses¥ |
SbV: pentavalent antimony.
* Not commercially available in the United States. Meglumine antimoniate may be obtained via an investigational new drug application to the US Food and Drug Administration (FDA).
¶ Effective dose for weight >75 kg may require higher dose off-label (with attendant gastrointestinal effects), aiming for >2.5 mg/kg dose.
Δ Topical paromomycin is not available in the United States. The paromomycin preparation needs to be specially prepared by a compounding pharmacy. Two compound preparations are available from licensed compounding pharmacies: 15% paromomycin ointment with methylbenzethonium chloride and 15% paromomycin cream with gentamicin. Refer to Lexicomp paromomycin monograph for further details.
◊ Miltefosine is FDA approved and commercially available in the United States. Miltefosine should not be used in females of childbearing age unless a validated contraceptive method is used during treatment and for at least 5 months following treatment.
§ Doses are expressed as mg of pentavalent antimony content. Duration of 10 days is appropriate for treatment of relatively mild disease with evidence of clinical response by day 10; otherwise, the duration should be extended. Duration of 20 days is appropriate for treatment of CL due to species known to cause mucosal disease. Meglumine antimoniate has 81 mg SbV/mL, while sodium stibogluconate (SSG) contains 100 mg SbV/mL. Intravenous treatment is usually diluted at least 10-fold with 5% dextrose in water and SSG is filtered.
¥ Pentam 300 contains 300 mg of pentamidine isethionate salt per vial. This is 171 mg pentamidine base.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
