From the Guidelines
For a 13-year-old female weighing 44 kg with a single superficial leishmaniasis lesion on the nasal bridge, I recommend sodium stibogluconate at a dose of 20 mg/kg/day for 28 days, as this duration is specified for the treatment of leishmaniasis in the provided guidelines 1. The total daily dose would be 880 mg (44 kg × 20 mg/kg), administered as a slow intravenous infusion over 5-10 minutes or intramuscularly.
Key Considerations
- The medication should be given once daily at the same time each day to maintain consistent blood levels.
- Before starting treatment, baseline laboratory tests including complete blood count, liver function tests, renal function tests, and electrocardiogram should be performed.
- During treatment, monitor for side effects including cardiac abnormalities, hepatotoxicity, pancreatitis, and renal impairment with weekly laboratory tests.
- Common adverse effects include pain at injection site, myalgia, arthralgia, and fatigue.
- The patient should be advised to maintain good hydration and report any unusual symptoms immediately.
- This pentavalent antimonial compound works by inhibiting parasitic glycolysis and fatty acid oxidation, thereby depleting ATP in the Leishmania parasite.
- For a facial lesion, particularly on the nasal bridge, systemic therapy is preferred over local treatment to ensure complete eradication and minimize scarring in this cosmetically sensitive area.
Additional Guidance
- According to the guidelines, the daily dose of sodium stibogluconate is 20 mg SbV /kg/day for 28 d 1.
- It is essential to follow the recommended treatment duration and dosage to ensure effective treatment and minimize the risk of resistance or relapse.
- The patient's response to treatment and any adverse effects should be closely monitored, and adjustments to the treatment plan should be made as necessary, considering the potential for drug interactions and the need for individualized care 1.
From the Research
Treatment of Leishmaniasis
The treatment of leishmaniasis typically involves the use of antimonial compounds, such as sodium stibogluconate (Pentostam).
- The recommended dose of sodium stibogluconate is 20 mg/kg/day, without an upper limit on the daily dose 2.
- This dose is recommended for all forms of leishmaniasis, including cutaneous, visceral, and mucosal leishmaniasis.
- The duration of treatment varies depending on the form of the disease, with cutaneous leishmaniasis typically treated for 20 days and visceral and mucosal leishmaniasis treated for 28 days 2.
Application to the Given Scenario
For a 13-year-old female child weighing 44 kilograms with a single superficial lesion at the nasal bridge, the calculated dose of sodium stibogluconate would be:
- 20 mg/kg/day x 44 kg = 880 mg/day
- This dose is consistent with the recommended treatment regimen for cutaneous leishmaniasis 2, 3.
- It is essential to note that the treatment should be administered under medical supervision, and the patient should be monitored for any potential side effects or complications 4, 5, 6.