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.
