infections
Leishmaniasis
Treatment of Leishmaniasis
Various medications, depending on several factors If mucosal leishmaniasis causes disfigurement, reconstructive surgery after successful drug therapy Consultation with an expert on the treatment of leishmaniasis is recommended. Doctors consider the following factors when selecting a medication to treat leishmaniasis: The form of the disease, whether it is cutaneous, mucosal, or visceral TheLeishmaniaspecies responsible The geographic location where the person was infected The likelihood that theLeishmaniaspecies is susceptible to treatment The status of the person's immune system The route of drug administration and the potential side effects Medications used to treat leishmaniasis include: Liposomalamphotericin B(also used to treat fungal infections) Miltefosine Amphotericin Bdeoxycholate (also used to treat fungal infections) Sodium stibogluconateand meglumine antimonate Fluconazoleor related medications (used to treat fungal infections) Liposomalamphotericin Bis most likely to be effective, but it has a number of potential side effects, must be given directly into the vein (intravenously), and is expensive.Amphotericin Bdeoxycholate is an alternative, but the side effects are more severe than withliposomal amphotericin B. Miltefosinehas the advantage of being taken by mouth, but it is not given to pregnant women because it may cause birth defects. Women of childbearing age who takemiltefosinemust use effective birth control measures. Sodium stibogluconateand meglumine antimonate can adversely affect the heart and other organs. The severity of side effects increases with the person's age. Resistance has been reported in many areas of the world. In the United States,sodium stibogluconateis no longer commercially available. Fluconazoleand related antifungal medications taken by mouth may be effective in some cases of cutaneous leishmaniasis. They are not used for mucosal or visceral leishmaniasis. For small, uncomplicated sores due toLeishmaniaspecies that do not cause mucosal leishmaniasis, treatment options include: Cryotherapy (freezing) or heat therapy applied to sores Paromomycinointment (an amebicide) applied topically to sores (not available in the United States) Sodium stibogluconateinjected into sores (not available in the United States for injection into sores) An antileishmanial medication Cryotherapy can be painful and is limited to small lesions. Heat therapy requires a special treatment device and is not widely available.Paromomycinointment andsodium stibogluconateinjected into the sore are not available in the United States. If a sore has started to heal on its own, doctors may observe it rather than treat it, provided the sore is caused by aLeishmaniaspecies that is not associated with mucosal leishmaniasis. If it continues to heal, no treatment is needed. Treatment with an antileishmanial medication is used For large, multiple, or potentially disfiguring sores When topical therapy is not available or fails For sores due toLeishmania braziliensisor related species in Latin America that cause mucosal leishmaniasis In people with a weakened immune system Of the antileishmanial medications, liposomalamphotericin Bormiltefosineare the most likely to be effective for cutaneous leishmanias. When a leishmania skin sore becomes secondarily infected with bacteria, an antibiotic effective for the treatment of skin and soft tissue infections is used. The medications of choice are Miltefosine Liposomalamphotericin B Eithermiltefosineby mouth or liposomalamphotericin Bby vein (intravenously) are used.Sodium stibogluconateand meglumine antimonate are alternatives for people infected in areas where resistance has not been reported. Reconstructive surgery may be needed if the nose or face is disfigured, but surgery should be delayed for 12 months after treatment to avoid losing a skin graft should a relapse occur. The medications of choice are Liposomalamphotericin B Alternatively,miltefosine Visceral leishmaniasis is a life-threatening disease, and liposomalamphotericin Bis the medication of choice.Miltefosinehas been effective in the treatment of visceral leishmaniasis in India and adjacent countries, but early signs of resistance have been reported there. Sodium stibogluconateor meglumine antimoniate, both antimony-containing medications, is the treatment of choice for visceral leishmaniasis; however, resistance is now widespread in India and some other countries, and side effects are a concern. They remain alternatives in areas of Latin America and Africa where resistance has not become a problem. Supportive measures, such as adequate nutrition, blood transfusions, or antibiotics to treat concurrent bacterial infections, may be needed along with antileishmanial therapy. is used to treat visceral leishmaniasis in people with Human Immunodeficiency Virus (HIV) Infection . In some people with AIDS and recurrent visceral leishmaniasis, liposomalamphotericin Bis given at regular intervals after initial treatment to prevent additional recurrences. 