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 for 28 days, which translates to 880 mg daily. This dosage is based on the guidelines provided by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH) 1. The medication should be administered intravenously (IV) or intramuscularly (IM), with the IV route preferred in North America for better tolerance.
The treatment regimen involves administering 20 mg SbV/kg/day for 28 days, with the dose diluted in D5W for IV administration over a 10-30 minute infusion, and an inline filter is recommended 1. It is crucial to monitor the patient's liver function, renal function, ECG, and complete blood count before starting treatment and weekly during therapy, as sodium stibogluconate can cause cardiotoxicity, hepatotoxicity, and other adverse effects.
Key considerations for the treatment include:
- Administering the medication at the same time each day to maintain consistent blood levels
- Ensuring the patient is well-hydrated during treatment
- Monitoring for severe adverse reactions, such as significant ECG changes or marked elevation of liver enzymes, and temporarily suspending treatment if necessary
- Understanding that sodium stibogluconate works by inhibiting parasitic enzymes involved in glycolysis and fatty acid oxidation, thereby killing the Leishmania parasites.
Given the potential for adverse effects, careful patient monitoring and management of side effects are essential components of the treatment plan, as outlined in the clinical practice guidelines by the IDSA and ASTMH 1.
From the Research
Dose of Sodium Stibogluconate for Leishmaniasis Treatment
The dose of Sodium Stibogluconate (Pentostam) for the treatment of leishmaniasis is as follows:
- 20 mg/kg body weight/day, without an upper limit on the daily dose 2
- For a 13-year-old female child weighing 44 kilograms, the dose would be:
- 20 mg/kg/day x 44 kg = 880 mg/day
Treatment Duration
The treatment duration for leishmaniasis with Sodium Stibogluconate varies depending on the form of the disease:
- Cutaneous leishmaniasis: 20 days 2
- Visceral and mucosal leishmaniasis: 28 days 2
- In one study, patients with visceral leishmaniasis were treated for 30 days 3
- In another study, a patient with visceral leishmaniasis was treated for 17 days due to side effects 4
Side Effects and Monitoring
Sodium Stibogluconate can cause side effects, and patients should be monitored closely during treatment:
- Side effects may include erosive gastritis, cholelithiasis, worsening hepatosplenomegaly, elevation of liver enzymes, pancreatitis, and electrocardiogram abnormalities 4
- Patients should be monitored for toxicity, and rescue treatment with alternative drugs may be necessary in case of unresponsiveness or severe side effects 3