Leishmaniasis medical therapy: Difference between revisions
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===Visceral Leishmaniasis=== | ===Visceral Leishmaniasis=== | ||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font><ref name=CDC>{{cite web|url=http://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html#dx| title=CDC - Parasites - Leishmaniasis}}</ref></SMALL> | |||
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'''Visceral Leishmaniasis''' | |||
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▸ '''Systemic Therapy (Parenteral)''' | |||
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▸ '''Systemic Therapy (Oral)''' | |||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Therapy (Parenteral)}} | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | |||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Systemic Therapy (Oral)}} | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''Patients that weight 33-44 kg:'''''<br> ▸ '''''[[Miltefosine]] <sup>†</sup> 50 mg PO q12h for 28 days''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''Patients that weight >45 kg:'''''<br> ▸ '''''[[Miltefosine]] <sup>†</sup> 50 mg PO q8h for 28 days''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen<sup>‡</sup>''''' | |||
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| style="font-size: 90%; padding: 5px 5px; background: #DCDCDC" align=left | ▸ '''''[[Ketoconazole]] 600 mg daily for 28 days''''' <br> OR <br> ▸ '''''[[Fluconazole]] 200 mg daily for 6 weeks''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left| <small>†The FDA-approved indications are limited to infection caused by three particular species, all three of which are New World species in the Viannia subgenus—namely, Leishmania (V.) braziliensis, L. (V.) panamensis, and L. (V.) guyanensis. <br> ‡ The "azoles" showed modest activity against some Leishmania species in some cases, but are not FDA approved</small> | |||
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==References== | ==References== |
Revision as of 17:21, 29 December 2014
Leishmaniasis Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Leishmaniasis medical therapy On the Web |
American Roentgen Ray Society Images of Leishmaniasis medical therapy |
Risk calculators and risk factors for Leishmaniasis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
Medical Therapy
- Treatment decisions should be individualized, with expert consultation.
- In general, all clinically manifest cases of visceral leishmaniasis and mucosal leishmaniasis should be treated, whereas not all cases of cutaneous leishmaniasis require treatment.
- The treatment approach depends in part on host and parasite factors.
- Some approaches/regimens are effective only against certain Leishmania species/strains and only in particular geographic regions.
- Even data from well-conducted clinical trials are not necessarily generalizable to other settings. Of particular note, data from the many clinical trials of therapy for visceral leishmaniasis in parts of India are not necessarily directly applicable to visceral leishmaniasis caused by L. donovani in other areas, to visceral leishmaniasis caused by other species, or to treatment of cutaneous and mucosal leishmaniasis.
- Special groups (such as young children, elderly persons, pregnant/lactating women, and persons who are immunocompromised or who have other comorbidities) may need different medications or dosage regimens.
Cutaneous Leishmaniasis
Therapy of cutaneous leishmaniasis may be indicated to: |
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- Decisions about whether and how to treat should be individualized.
- The treatment approach depends in part on the Leishmania species/strain and the geographic area in which infection was acquired; the natural history of infection, the risk for mucosal dissemination/disease, and the drug susceptibilities in the pertinent setting; and the number, size, location, evolution, and other clinical characteristics of the patient's skin lesions.
- In general, the first sign of a therapeutic response to adequate treatment is decreasing induration (lesion flattening).
- The healing process for large, ulcerative lesions often continues after the end of therapy.
- Relapse (clinical reactivation) typically is noticed first at the margin of the lesion.
Medical Therapy
▸ Click on the following categories to expand treatment regimens.[1]
Cutaneous Leishmaniasis ▸ Systemic Therapy (Parenteral) ▸ Systemic Therapy (Oral) ▸ Local Therapy |
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Visceral Leishmaniasis
▸ Click on the following categories to expand treatment regimens.[1]
Visceral Leishmaniasis ▸ Systemic Therapy (Parenteral) ▸ Systemic Therapy (Oral) |
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