A 30-year-old man from Assam presents with prolonged fever, splenomegaly, weight loss, and pancytopenia. Bone marrow biopsy shows Leishman-Donovan bodies in macrophages. Serological test shows positive rK39 ICT. Which treatment is NOW considered first-line in India for visceral leishmaniasis?

• A Miltefosine 2.5 mg/kg/day for 28 days
• B Sodium stibogluconate 20 mg/kg/day for 30 days
• C Pentamidine isethionate 4 mg/kg alternate day for 15 doses
• D Single-dose liposomal amphotericin B 10 mg/kg ✓

Explanation

As per NVBDCP and WHO recommendations for the Indian subcontinent, single-dose liposomal amphotericin B (AmBisome) 10 mg/kg IV is the current first-line treatment for visceral leishmaniasis (kala-azar) due to high efficacy (>95% cure rate), single-dose convenience, and minimal nephrotoxicity compared to conventional amphotericin B. Miltefosine is an oral alternative but is contraindicated in pregnancy and has emerging resistance. Antimonials (sodium stibogluconate) are no longer first-line in India due to widespread resistance, particularly in Bihar.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.