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Leishmaniasis

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30 Treatment Footnotes for Tables 3a, 3b & 3c 1. For simplicity, the terminolog y North America is used to refer to the United States and Canada. 2. All treatment-related decisions should be individualized. The lists of treatment approaches/drugs and regimens are not all inclusive. For the listed systemic drugs, see Table 4 regarding adverse events, monitoring for toxicity, and mitigation approaches. See Recs. 61–66, 70–77 regarding treatment considerations applicable to HIV-coinfected persons and to persons who are immunocompromised for other reasons. See Recs. 78–79 for considerations for other special populations of patients (eg, young children). 3. See Table 1 and Recs. 24–37 for additional perspective. 4. The pentavalent antimonial drugs—sodium stibogluconate (Pentostam ® ) and meglumine antimoniate (Glucantime ® )—are considered comparable when dosed on the basis of Sb V content. In general, the daily dose does not have an upper limit in mgs (ie, the daily dose no longer is limited to 850 mg ); however, see Recs. 78–79 for additional perspective and cautionary notes. 5. Persons newly diagnosed with VL should be assessed for concurrent HIV/AIDS or other causes of cell-mediated immunosuppression. 6. Liposomal amphotericin is approved by the U.S. Food and Drug Administration for the treatment of VL. The off-label use of amphotericin B deoxycholate is likely to be effective but is generally more toxic (see Table 4). 7. An immunocompetent person is defined as someone without an identified congenital or acquired immune defect (eg, HIV/AIDS). In general, L. donovani (India) may be treated with a shorter course of ABLC, whereas L. infantum in Europe requires 10 days duration.

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