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©2013 UpToDate ® Print Email Drug regimens for treatment of cutaneous leishmaniasis in adults [1-3] Drug Dose Local therapy Pentavalent antimonials Sodium stibogluconate* 0.5 to 2 mL intralesionally every three to seven days until healed Meglumine antimoniate Δ 0.5 to 2 mL intralesionally every three to seven days until healed Paromomycin Paromomycin ointment ◊ Apply topically to lesions twice daily for 10 to 20 days WR 279396 cream § Apply topically to lesions once daily for 20 days Oral systemic therapy Azoles Fluconazole 200 to 600 mg orally once daily for six weeks Ketoconazole 600 mg orally once daily for 28 days Itraconazole 100 to 200 mg orally twice daily for 28 days Miltefosine Miltefosine Δ 2.5 mg/kg (maximum 150 mg) orally once daily for 28 days Parenteral systemic therapy Pentavalent antimonials Sodium stibogluconate 20 mg/kg/day intravenously or intramuscularly for 10 to 20 days ¥ Meglumine antimoniate 20 mg/kg/day intravenously or intramuscularly for 10 to 20 days ¥ Amphotericin Amphotericin B deoxycholate 0.5 to 1 mg/kg intravenously every other day for 20 to 30 days Liposomal amphotericin B (AmBisome) 3 mg/kg intravenously daily for five to seven doses; if immunocompromised host then give 4 mg/kg for ten or more doses Pentamidine Pentamidine isethionate 2 to 4 mg/kg intravenously or intramuscularly every other day for four to seven doses or until healed Agents listed, dosage regimens, and combinations are effective only against certain Leishmania species/strains and only in certain areas of the world. The therapeutic approach to cutaneous leishmaniasis is discussed in the topic 'Treatment of cutaneous leishmaniasis.' Pediatric dosing is summarized separately [3] . * In the United States, may be obtained from CDC Drug Services telephone 404-639-3670 or 404-639-2888 (nights, weekends). Δ Not commercially available in US. It may be possible to obtain via investigational new drug application. ◊ Compounding instructions and additional information is summarized separately [3] . § For treatment of CL among military healthcare beneficiaries in the United States, may be obtained from US Army Medical Materiel Development Activity. ¥ Duration of 10 days is appropriate for treatment of relatively mild disease with evidence of clinical response by day 10; otherwise, the duration should be extended. Duration of 20 days is appropriate for treatment of CL due to species known to cause mucosal disease. Courtesy of authors with additional data from:

Agents listed, dosage regimens, and combinations are effective only against certain Leishmania species/strains and only in certain areas of the world. The therapeutic approach to cutaneous leishmaniasis is discussed in the topic 'Treatment of cutaneous leishmaniasis.' Pediatric dosing is summarized separately [3] . * In the United States, may be obtained from CDC Drug Services telephone 404-639-3670 or 404-639-2888 (nights, weekends). Δ Not commercially available in US. It may be possible to obtain via investigational new drug application. ◊ Compounding instructions and additional information is summarized separately [3] . § For treatment of CL among military healthcare beneficiaries in the United States, may be obtained from US Army Medical Materiel Development Activity. ¥ Duration of 10 days is appropriate for treatment of relatively mild disease with evidence of clinical response by day 10; otherwise, the duration should be extended. Duration of 20 days is appropriate for treatment of CL due to species known to cause mucosal disease. Courtesy of authors with additional data from: Goto H and Laulett Lindoso JA; Cutaneous and mucocutaneous leishmaniasis; Inf Dis Clin N Am 2012; 26:293. Parasites - Leishmaniasis; Centers for Disease Control and Prevention file://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html#tx (accessed March 25, 2013). Drugs for parasitic infections 2nd ed; The Medical Letter 2010; New Rochelle N.Y. p.26.