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Leishmaniasis

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34 Pentavalent antimonial (Sb V ) compounds Sodium stibogluconate (Pentostam®) and meglumine antimoniate (Glucantime®) (IV, IMa) Various symptoms (eg, myalgia, large- joint arthralgia, headache, malaise, fatigue, anorexia, nausea) commonly noted as treatment course progresses. Laboratory abnormalities usually reversible (during or aer treatment), including elevated aminotransferase, lipase, and amylase values (see Recs. comments). Also, ECG abnormalities (eg, nonspecific ST-T-wave changes. Less oen, clinically relevant QTc prolongation) and cytopenias (in VL, pretreatment cytopenias typically improve during therapy). Baseline and weekly serum chemistry values (eg, aminotransferase s, lipase/ amylase, potassium, creatinine, BUN, glucose), CBC, and ECG. More frequent monitoring may be indicated or prudent for some patients (see Recs. 78-79). Others Pentamidine Isethionate (IV, IM) Various symptoms (eg, nausea, vomiting, dysgeusia, headache); hypo/hyperglycemia, insulin- dependent diabetes mellitus (may be diagnosed up to several months posttreatment), pancreatitis, hypotension, QTc prolongation, nephrotoxicity, hyperkalemia, hypocalcemia, hepatoxicity, cytopenias (leukopenia/thrombocytopenia > anemia), rhabdomyolysis. If IM: also pain and sterile abscesses at injection sites. Assess before, during, and aer therapy: serum chemistry values, CBC, and ECG. Monitor fasting glucose level (and urinalysis) before each dose and ~3 weeks and ~2–3 months post-treatment. If indicated (if potential for rhabdomyolysis), check or monitor CPK level. Table 4. Drugs Used in North America for Systemic a Antileishmanial Therapy: Adverse Events, Monitoring for Toxicity, and Mitigation Approaches b (cont'd) Drug c (Route(s) of Administration) Adverse Events d,e Laboratory Monitoring for Toxicity d,f Treatment

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