Guideline

WHO guidelines on leishmaniases: treatment of visceral leishmaniasis and post-kala-azar dermal leishmaniasis in eastern Africa and South-East Asia

Year of Publication

2026

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

10 included recommendations

Management of visceral leishmaniasis (VL) patients in eastern Africa. Use of a combination of paromomycin plus miltefosine is suggested rather than a combination of sodium stibogluconate (SSG) plus paromomycin

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

Management of visceral leishmaniasis (VL) patients in eastern Africa. Use of a combination of sodium stibogluconate (SSG) plus paromomycin is suggested rather than SSG monotherapy in patients in whom paromomycin plus miltefosine is excluded .

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

Management of visceral leishmaniasis (VL) patients in eastern Africa. Use of liposomal amphotericin B (LAmB) is suggested in patients in whom paromomycin plus miltefosine and/or pentavalent antimonial plus paromomycin is excluded

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

Visceral leishmaniasis (VL) relapse in South-East Asia. In settings in which primary VL in immunocompetent patients was treated with single-dose liposomal amphotericin B (LAmB) (10 mg/kg by infusion over 2 h), a parasitologically confirmed case of relapse should not be treated with a single dose of LAmB (10 mg/kg by infusion over 2 h).

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

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)

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

Visceral leishmaniasis (VL) relapse in South-East Asia. For relapse cases that are not eligible for combination regimens, higher doses of liposomal amphotericin B (LAmB) up to a total dose of 15–20 mg/kg should be administered in three or four administrations.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

Post-kala-azar dermal leishmaniasis (PKD)L in eastern Africa. A combination of paromomycin plus miltefosine is suggested rather than a combination of liposomal amphotericin B (LAmB) and miltefosine

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

Post-kala-azar dermal leishmaniasis (PKD)L in South-East Asia. Liposomal amphotericin B (LAmB) (total dose, 30 mg/kg administered IV in six doses of 5 mg/kg twice a week for 3 weeks) is suggested rather than miltefosine (2.5 mg/kg to children between 2-11 years or 100 mg/day orally for 12 weeks in divided doses).

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

Post-kala-azar dermal leishmaniasis (PKD)L in South-East Asia. A combination of Liposomal amphotericin B (LAmB) (total dose, 20 mg/kg administered IV on days 1, 4, 8, 11 and 15) plus miltefosine (allometric dose orally BID for 21 days) or LAmB monotherapy (total dose, 20 mg/kg administered IV on days 1, 4, 8, 11 and 15) is suggested for the treatment of PKDL.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low

Post-kala-azar dermal leishmaniasis (PKD)L in South-East Asia. A combination of Liposomal amphotericin B (LAmB) (total dose, 15 mg/kg administered IV on days 1, 8 and 15) plus miltefosine (100 mg/day orally after the first dose of LAmB and daily until the end of 45 days) is suggested rather than miltefosine monotherapy (100 mg/day orally for 90 days).

Status

New

Recommended in favor

Conditional

Certainty of evidence

Very low