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KALA-AZAR OR VISCERAL LEISHMANIASIS   What is the Treatment of Kala-azar? Kala-azar Drugs available in India Sodium Stibogluconate (indigenous manufacture, registered for use & sale) Pentamidine Isethionate: (imported, registered for use) Amphotericin B: (indigenous manufacture, registered for use and sale) Liposomal Amphotericin B: (indigenous manufacture & import, registered for use and sale) Miltefosine (imported/ registered for use & sale) Drug Policy under Kala-azar Elimination Programme as per recommendations of Expert Committee (2000) - (This drug policy is under review) First Line Drugs Short Term Areas with SSG sensitivity >90% » SSG IM/IV 20mg/kg/day X 30 days Areas with SSG sensitivity <90% » Amphotericin B 1mg/kg b.w. IV infusion daily or alternate day for 15-20 infusions. Dose can be increased in patients with incomplete response with 30 injections B. Long Term Areas with high level of SSG resistance (>20%) » Miltefosine 100 mg daily x 4 weeks (after phase III studies completed with proven safety & efficacy) Areas with SSG sensitivity >80% » SSG IM/IV 20mg/kg/day X 30 days » Miltefosine 100 mg daily x 4 weeks (after phase III studies completed with proven safety & efficacy) Second Line Drugs SSG Failures » Amphotericin B 1mg/kg b.w. IV infusion daily or alternate day for 15-20 infusions. Dose can be increased in patients with incomplete response with 30 injections B. SSG and Miltefosine Failures » Liposomal Amphotericin B (when final results are available with proven efficacy and safety) Treatment of PKDL » SSG in usual dosages for KA could be given up to 120 days » Repeated 3-4 courses of Amphotericin B can be given in patients failing SSG treatment

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