Zheng Qi   2021-03-21

 Regimens

VL treatment prioritizes complete parasite clearance to prevent fatal complications, reduce long-term relapse risk, and curb the spread of drug-resistant parasite strains. The traditional first-line regimen in non-resistant endemic regions uses pentavalent antimony compounds at a standard dose of 20mg/kg per day for 30 consecutive days, which achieves an initial clinical improvement rate of 83%. For regions with widespread antimony resistance, liposomal amphotericin B is the preferred first-line option, with a total cumulative dose of 20~30mg/kg administered via slow intravenous infusion over several weeks, offering over 90% cure rate with far fewer severe adverse effects than conventional amphotericin B. Miltefosine, the first oral antileishmanial drug, is also widely deployed for VL treatment at a daily adult dose of 100mg for 28 days, making it highly suitable for remote endemic settings where regular hospital visits for intravenous infusion are difficult to arrange.

Cutaneous Leishmaniasis (CL) Management

CL treatment covers a full spectrum of topical, systemic and non-pharmacological options to promote ulcer healing and minimize permanent scarring. For small, localized, non-critical lesions, minimally invasive local therapies are the first choice: these include intralesional injection of pentavalent antimony solutions, topical application of 15% paromomycin ointment, localized radiofrequency thermotherapy that maintains lesion temperature at 42℃ for targeted parasite destruction, and cryotherapy using liquid nitrogen to eliminate small nodular lesions. For cases with multiple widespread lesions, lesions located on the face or joints, or cases that do not respond to local treatment, systemic therapies including oral miltefosine, intravenous pentavalent antimony or amphotericin B are prescribed to ensure full parasite clearance. All CL treatment courses require regular follow-up for at least 12 months to monitor for recurrence, and patients are advised to keep lesions clean and covered to prevent secondary bacterial infections.

Special Population Considerations

For vulnerable groups including children, pregnant people, and patients with pre-existing liver or kidney dysfunction, treatment plans require careful dose adjustment and close monitoring of organ function to avoid severe adverse reactions. PKDL and mucocutaneous leishmaniasis cases require extended, tailored treatment courses, as these forms of the disease are far more likely to relapse and can act as persistent parasite reservoirs that sustain ongoing local sandfly-borne transmission.

Edited by: Secretariat of the Asia-Pacific Network for Drug and Diagnostics Innovation
Produced by: Zheng Qi
Reviewed by: Zhang Haobing
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