Recommendations
| Дозування | Ремарки | |
|---|---|---|
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liposomal amphotericin B (Ambisome) IV 20 mg/kg
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Immunocompetent host 1st choice Total dose of 20 mg/kg over 2–7 days depending on the species. Preferably: 10 mg/kg once daily on two consecutive days. |
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Immunocompetent host 2nd choice Miltefosine 150 mg per day in 2–3 doses, for 28 days |
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liposomal amphotericin B (Ambisome) IV 40 mg/kg total
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Immunodeficient host and patient with HIV and CD4<350/mm3 1st choice Total dose of 40 mg/kg over 4–8 days depending on the species |
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Immunodeficient host and patient with HIV and CD4<350/mm3 2nd choice Miltefosine 150 mg per day in 2–3 doses, for 6 weeks |
| Дозування | Ремарки | |
|---|---|---|
|
Molecular typing (on a biopsy) always required. Treatment depends on the species, location and number of lesions. Consult an expert (infectious diseases specialist or clinical microbiologist). |
Treatment is complex and tailored to the individual patient and the form of Leishmania. Therefore consult an expert first.
For a more detailed overview by species, the article by Hodiamont et al. can be consulted.
Miltefosine is not licensed and not available in the Netherlands. If required, approval from the IGJ and import from abroad are necessary. This is expected to take approximately 1–2 weeks.
Miltefosine is contraindicated in pregnant women, during lactation up to 5 months afterwards, and in children younger than 12 years (CDC advice).
Dosing of miltefosine in children can be optimised according to Dorlo et al.
Secondary prophylaxis for visceral leishmaniasis in the immunodeficient host
• Monitor regularly using molecular diagnostics on whole blood. If positive again, resume treatment and consider longer-term secondary prophylaxis.
• In patients with HIV: continue until CD4>350/mm3 for at least 3 months.