Review of the current treatments for leishmaniases

Figures & data

Table 1 Clinical manifestations of leishmaniasis and related Leishmania species

Clinical manifestation	Leishmania species	Geographical area
Localized cutaneous leishmaniasis	L. (L.) tropica	Old World
	L. (L.) major	Old World
	L. (L.) aethiopica	Old World
	L. (L.) amazonensis of subgenus Viannia	New World
		New World
Disseminated cutaneous leishmaniasis	L. (V.) braziliensis	New World
	L. (L.) amazonensis	New World
Diffuse cutaneous leishmaniasis	L. (L.) mexicana	New World
	L. (L.) amazonensis	New World
	L. (L.) aethiopica	Old World
Leishmaniasis recidivacutis	L. (L.) tropica	Old World
	L. (V.) braziliensis	New World
	L. (L.) amazonensis	New World
	L. (V.) panamensis	New World
Mucosal leishmaniasis	L. (V.) braziliensis	New World
	L. (V.) panamensis	New World
	L. (V.) guyanensis	New World
	L. (L.) amazonensis	New World
	L. (L.) major	Old World
Visceral leishmaniasis	Leishmania (L.) donovani	Old World, except Europe
	Leishmania (L.) infantum	Europe, Africa, and New World

Table 2 Medicines with doses used to treat tegumentary and visceral leishmaniasesa

	Pentavalent antimonials	Amphotericin B deoxycholate	Liposomal amphotericin B	Pentamidine isethionate	Miltefosine
Localized cutaneous leishmaniasis	10–20 mg/Sb^+5/kg/day (iv or im) 10–20 days	1 mg/kg/day (iv) Total dose: 1.0–1.5 g		4 mg/kg/day (im) Maximum dose: 2 g	2.5 mg/kg (oral) 28 days to treat L. mexicana
Disseminated cutaneous leishmaniasis	20 mg/Sb^+5/kg/day (iv or im) 28 days	1 mg/kg/day (iv) Total dose: 1.0–1.5 g		4 mg/kg/day (im) Maximum dose: 2 g
Diffuse cutaneous leishmaniasis	20 mg/Sb^+5/kg/day (iv or im) 28 days			Not used	Not used
Leishmaniasis recidiva cutis	15–20 mg Sb^+5/kg (iv or im) per day for 28 daysb
Mucosa leishmaniasis	20 mg/Sb^+5/kg/day (iv or im) 30 days	1 mg/kg/day (iv) Total dose: 2.0–2.5 g	2–3 mg/kg/day (iv) Total dose: 40–60 mg/kg	Not used	2.5 mg/kg (oral) 28 daysc
Visceral leishmaniasis	20 mg/Sb^+5/kg/day (iv or im) for 28 daysd	0.75–1.00 mg/kg/day (iv) 15–20 doses	3–4 mg/kg/day (iv) Total dose: 15–24 mg/kg	Not used	2.5 mg/kg (oral) 28 dayse

Notes:

a Doses and time of treatment were based on WHO recommendation from 2010;

b in case of no response to the usual dose of Sb⁺⁵, Sb⁺⁵plus allopurinol 20 mg/kg for 30 days is indicated when L. tropica is the agent;

c only in Bolivia;

d except Bihar (Indian subcontinent);

e only in the Indian subcontinent.

Abbreviations: Sb⁺⁵, pentavalent antimonial; iv, intravenous; im, intramuscular.