Visceral Leishmaniasis

Diagnosis and treatment

microscopy or PCR in smears, body fluids or tissue

Notes on treatment:
see also Anti-infective/ART interaction table for treatment optimization

  Drug / Dose Comments
Preferred treatment  liposomal amphotericin B 
2-4 mg/kg qd iv for 10 consecutive days
Then secondary prophylaxis
liposomal amphotericin B
4 mg/kg qd iv on day 1-5, 10, 17, 24, 31 and 38

Alternative therapy    lipid complex amphotericin B
3 mg/kg qd iv
10 days
amphotericin B deoxycholate
0.5-1 mg/kg qd iv (total dose 1.5-2 g)

liposomal amphotericin B
5 mg/kg every other day (days 1, 3, 5, 7, 9, 11)
+ Milltefosine
50 mg bid for 14 days

The efficacy of this regimen has not been assessed in regions where L. infantum is prevalent (i.e. Europe, Mediterranean basin)
pentavalent antimonium salt (Glucantime®)
20 mg/kg qd iv or im
4 weeks
1.5-2.5 mg/kg qd po
4 weeks
Efficacy of miltefosine can vary in different Leishmania spp. and has been reported to be lower in L. infantum

Secondary Prophylaxis / Maintenance Therapy

Consider stopping: if CD4 count > 200-350 cells/μL and HIV-VL undetectable over 3 months, no relapse for at least 6 months and negative PCR in blood or negative urinary antigen

  Drug / Dose
Preferred treatment liposomal amphotericin B
4 mg/kg every 2-4 weeks iv
lipid complex amphotericin B
3 mg/kg every 3 weeks iv
Alternative therapy pentavalent antimonium salts (Glucantime®)
20 mg/kg every 4 weeks iv/im
100 mg qd po
300 mg every 3 to 4 weeks iv