Bibliographic information
Recommendation
Visceral leishmaniasis (VL) relapse in South-East Asia. When available, a combination of drugs (co-administered) can be used to treat relapse cases. ⸋ miltefosine plus paromomycin, both daily for 10 days ⸋ liposomal amphotericin B (LAmB) (5 mg/kg by infusion, single dose) plus miltefosine (daily for 7 days) ⸋ LAmB (5 mg/kg by infusion, single dose) plus paromomycin (daily for 10 days)
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
allometric doses of miltefosine. paromomycin sulfate 15 mg (11 mg base) per kg/body weigth per day intramuscularly
⸋ Relapse patients should be diagnosed parasitologically. ⸋ The choice of drugs should include consideration of availability, feasibility and cost. ⸋ Mitefosine should be administered by allometric dosing, particularly for patients weighing<30 kg.
Diagnosis of VL relapse requires parasitological confirmation, as serological tests remain positive for several years after cure due to the persistence of antibodies, and the tests cannot reliably distinguish between active and past infection. Polymerase chain reaction (PCR) testing for parasite DNA in blood or bone-marrow aspirates is substantially more sensitive than microscopy, but its use is currently limited to referral hospitals and research centres. In the future, quantitative PCR techniques may be more specific for clinical disease, although proper standardization of PCR techniques and evaluation of their diagnostic accuracy in representative clinical settings are necessary. Until new tests for confirmation of cure are available, diagnosis of relapse cases will require parasitological confirmation.