A 7-year-old child from a rural area is diagnosed with kala-azar (visceral leishmaniasis). After completing a full course of sodium stibogluconate (SSG), fever resolves but returns after 3 months with splenomegaly and pancytopenia. Tests confirm relapse with SSG-resistant L. donovani. What is the DRUG OF CHOICE for this child?

• A Meglumine antimoniate (Glucantime)
• B Miltefosine
• C Paromomycin IM
• D Liposomal amphotericin B (AmBisome) ✓

Explanation

Liposomal amphotericin B (L-AmB) is the first-line treatment for SSG-resistant or SSG-refractory visceral leishmaniasis in children, with an excellent cure rate (>95%) and low toxicity due to preferential uptake by the reticuloendothelial system. Miltefosine is an oral option but is teratogenic and less preferred in young children due to GI side effects; it is mainly used in adults. Meglumine antimoniate is another pentavalent antimonial like SSG — cross-resistance renders it ineffective. Paromomycin is used as part of combination therapy but not as monotherapy for resistant cases.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.