From the Research
Itraconazole is not a first-line treatment for leishmaniasis in children, and its use should be considered only after consultation with an infectious disease specialist due to its limited efficacy and potential for hepatotoxicity. For a 13-year-old female weighing 44 kg with leishmaniasis, the recommended treatments would instead be liposomal amphotericin B (3-5 mg/kg/day for 3-5 days), pentavalent antimonials (20 mg/kg/day for 20-30 days), or miltefosine (2.5 mg/kg/day for 28 days) 1.
Key Considerations
- The most effective treatment for leishmaniasis is liposomal amphotericin B, which has been shown to be virtually 100% effective for Indian visceral disease at a total dose of 15 mg/kg and is 90% effective at a dose of 5-10 mg/kg 1.
- Miltefosine is also an effective oral agent, with a cure rate of more than 95% for Indian visceral disease 1.
- Itraconazole has shown limited efficacy against leishmaniasis and is generally not included in standard treatment protocols, but if used, the dose would typically be 5-8 mg/kg/day (approximately 200-300 mg daily for this patient) divided into two doses for 4-6 weeks, taken with food to enhance absorption 2.
Monitoring and Precautions
- Treatment with itraconazole should include regular monitoring of liver function tests, as it can cause hepatotoxicity.
- The patient should also be monitored for clinical improvement and potential drug interactions, as itraconazole affects the metabolism of many medications through the cytochrome P450 system.
- Fluconazole has been shown to be effective in treating cutaneous leishmaniasis, particularly in cases caused by Leishmania major, with a dose of 6 mg/kg/day for 6 weeks 3.