Drug and Dose | Mechanism of Action | Duration of Treatment | Common Side Effects | Time to Relapse/Recrudescence | Drug Resistance |
---|---|---|---|---|---|
Meglumine antimoniate* (50 mg/kg twice daily SC or 100 mg/kg/day) | Inhibition of parasite phosphofructokinase metabolism | 4-6 weeks | Local pain at site of injection, pancreatitis, nephrotoxicity | 6-12 months | Reported |
Miltefosine (2 mg/kg daily) | Impairment of signaling pathways and cell membrane synthesis | 4 weeks | Anorexia, vomiting, diarrhea | 4-6 months | Not reported |
Paromomycin* (4 mg/kg SC) | Interference with mitochondrial pathway | 3 weeks | Nephrotoxicity, ototoxicity | 3-4 months | Not reported |
Allopurinol (10 mg/kg, PO, twice daily) | Interference with purine metabolism | 6-24 months | Xanthinuria, urolithiasis, renal mineralization | Not well documented | Reported |
Meglumine antimoniate* (50 mg/kg,SC, twice daily or 100 mg/kg daily) + allopurinol (10 mg/kg, PO, twice daily) | Inhibition of parasite phosphofructokinase metabolism and interference with purine metabolism | 4 weeks (meglumine antimoniate) and 6-12 months (allopurinol) | Local pain at site of injection, pancreatitis, nephrotoxicity; xanthinuria, urolithiasis, renal mineralization | Not reported | Not reported |
Miltefosine (2 mg/kg daily) + allopurinol (10 mg/kg, PO, twice daily) | Impairment of signaling pathways and cell membrane synthesis and interference with purine metabolism | 4 weeks (miltefosine) and 6-12 months (allopurinol) | Anorexia, vomiting, diarrhea, xanthinuria, urolithiasis, renal mineralization | Not reported | Not reported |
Marbofloxacin (2 mg/kg daily) | Inhibition of DNA gyrase | 4 weeks | Not reported | 3-6 months | Not reported |
Liposomal amphotericin B (3 mg/kg, IV, every 2 days) | Inhibition of cholesterol incorporation into cell membrane. | To total of 21 mg/kg over 2-3 weeks as tolerated | Diarrhea, vomiting, nephrotoxicity | Not reported | Not reported |
*not commercially available in the USA. Adapted from Miro et al: Novel Areas for Prevention and Control of Canine Leishmaniosis. Trends Parasitol. 2017; 33(9)718-730. |