From the Guidelines
For a 13-year-old female child weighing 44 kg with leishmaniasis, the recommended dose of sodium stibogluconate is 20 mg/kg/day, which equals 880 mg daily. This medication should be administered once daily by slow intravenous or intramuscular injection for 20-28 days, depending on the type of leishmaniasis (cutaneous typically requires 20 days, while visceral leishmaniasis requires 28-30 days) 1. The solution should be given slowly to avoid adverse reactions like cough, chest pain, or vomiting. Before starting treatment, baseline laboratory tests including complete blood count, liver and kidney function tests, and ECG should be performed, with regular monitoring throughout therapy 1. Common side effects include pain at injection site, myalgia, arthralgia, and potential cardiotoxicity. Treatment should be administered in a healthcare setting with appropriate monitoring capabilities. Sodium stibogluconate works by inhibiting parasitic enzymes and disrupting energy metabolism in the Leishmania parasite. If treatment failure occurs or in cases of severe disease, alternative medications like amphotericin B or miltefosine may be considered 1. Some key points to consider when administering sodium stibogluconate include:
- Monitoring for adverse events such as myalgia, arthralgia, and cardiotoxicity
- Avoiding the use of other nephrotoxic agents
- Regular monitoring of laboratory tests, including complete blood count, liver and kidney function tests, and ECG
- Administering the medication in a healthcare setting with appropriate monitoring capabilities
- Considering alternative medications in cases of treatment failure or severe disease. It is also important to note that the daily dose of sodium stibogluconate does not have an upper limit in milligrams, but see 1 for additional perspective and cautionary notes. Additionally, patients with advanced immunosuppression may have life-threatening pancreatitis or cardiotoxicity, and special considerations should be taken for children and other special populations 1.
From the Research
Dose of Sodium Stibogluconate for Leishmaniasis Treatment
- The recommended dose of Sodium Stibogluconate (Pentostam) for the treatment of leishmaniasis is 20 mg/kg/day 2.
- This dose is recommended for all forms of leishmaniasis, including visceral, cutaneous, and mucosal leishmaniasis 2.
- The treatment duration varies depending on the form of leishmaniasis, with cutaneous leishmaniasis typically treated for 20 days and visceral and mucosal leishmaniasis treated for 28 days 2.
- For a 13-year-old female child weighing 44 kilograms, the calculated dose would be 20 mg/kg/day * 44 kg = 880 mg/day.
- This dose is consistent with the recommendation to remove the 850-mg restriction on the daily dose of antimony, as recent efficacy and toxicity data suggest that a regimen of 20 mg/kg/day of pentavalent antimony is more efficacious and not substantially more toxic than regimens with lower daily doses 2.
- A case report of a 12-year-old patient treated with sodium stibogluconate at a dose of 20 mg/kg body weight/day for 17 days also supports this recommendation 3.