Dawaa Reference

infectious

Cutaneous Leishmaniasis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

CDC Yellow Book 2024 · WHO Control of the Leishmaniases Technical Report 2010 · WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations

Verified against4 documents
  • CDC Yellow Book 2024
  • WHO Control of the Leishmaniases Technical Report 2010
  • WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations
  • Cutaneous Leishmaniasis - disease-level clinical article (cutaneous-leishmaniasis-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • An asymptomatic papule or nodule appears at the inoculation site after a 2 to 4 week incubation [papules]
  • Lesions often heal on their own within 2 to 5 years, leaving a depressed scar [scarring]
  • Diffuse cutaneous disease begins as a painless nodule that can spread over the entire skin surface
  • Visceral disease features fever, an enlarged spleen, and pancytopenia [fever · splenomegaly]

Signs — what you find (4)

  • A well-defined ulcer with a raised violet-colored border and epidermal breakdown
  • Diffuse cutaneous lesions favor the face, ears, and extensor surfaces of the knees and elbows [skin lesions]
  • Progressive diffuse disease can cause leonine facies
  • The post-kala-azar dermal rash is papular, appearing on the face and arms once visceral disease is treated [papules · rash]

Tests (6)

  • Tissue histopathology is the gold standard but has low sensitivity, improved by the press-imprint-smear technique
  • Micro-culture techniques reach up to 98.4 percent sensitivity and 100 percent specificity
  • An intradermal skin test reaction of 5 mm or more is considered positive
  • Skin testing cannot tell a past infection from an active one
  • PCR and nucleic acid amplification testing are increasingly used and are both sensitive and specific
  • Direct agglutination testing for visceral disease reaches 97 to 100 percent sensitivity and 86 to 92 percent specificity

If not this — what else fits (4)

  • Furuncular myiasis is on the differential for tropical skin ulcers
  • Lepromatous leprosy is a differential, also presenting with leonine facies
  • Tuberculoid leprosy presents with hypopigmented patches and plaques
  • Yaws causes ulcerative or nodular lesions on the lower extremities in its primary stage

SourceStatPearls "Leishmaniasis" - disease-level clinical article

Presentation findings are traced to the source above.

1

MEGLUMINE ANTIMONIATE

1st line

Strength85 mg

Forminjection

Adult dose and duration

Intralesional 0.5-5 mL per session (or 20 mg Sb5+/kg/day IM/IV for 20 days) x 2-4 weeks under specialist care

Paediatric dose

20 mg/kg/day [child max 850 mg]

(20 mg Sb5+/kg/day IM/IV for 20 days under specialist supervision)

Dose by weight
3kg60 mg/day
4kg80 mg/day
5kg100 mg/day
6kg120 mg/day
7kg140 mg/day
8kg160 mg/day
9kg180 mg/day
10kg200 mg/day
11kg220 mg/day
12kg240 mg/day
13kg260 mg/day
14kg280 mg/day
15kg300 mg/day
16kg320 mg/day
17kg340 mg/day
18kg360 mg/day
19kg380 mg/day
20kg400 mg/day
21kg420 mg/day
22kg440 mg/day
23kg460 mg/day
24kg480 mg/day
25kg500 mg/day
26kg520 mg/day
27kg540 mg/day
28kg560 mg/day
29kg580 mg/day
30kg600 mg/day
31kg620 mg/day
32kg640 mg/day
33kg660 mg/day
34kg680 mg/day
35kg700 mg/day
36kg720 mg/day
37kg740 mg/day
38kg760 mg/day
39kg780 mg/day
40kg800 mg/day
41kg820 mg/day
42kg840 mg/day
43kg850 mg/day (capped)
44kg850 mg/day (capped)
45kg850 mg/day (capped)
46kg850 mg/day (capped)
47kg850 mg/day (capped)
48kg850 mg/day (capped)
49kg850 mg/day (capped)
50kg850 mg/day (capped)
Dose source

WHO Control of the Leishmaniases Technical Report 2010

Why

Meglumine antimoniate is not available in commercial Egyptian retail pharmacies; pentavalent antimonials are supplied via Ministry of Health/WHO programs.

Cautions
  • Monitor for cardiotoxicity (QT prolongation) and pancreatitis.
  • Unregistered in commercial Egyptian pharmacies; supplied through specialized MOH/WHO programs.
  • Requires specialist endemic disease referral; check baseline ECG, renal and pancreatic enzymes if giving IM/IV.
Egyptian brands

No Egyptian brand matched — prescribe by generic name.

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Leishmaniasis - disease-level clinical article (cutaneous-leishmaniasis-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - There is a risk of severe and life-threatening mucosal disease spread.
3

FLUCONAZOLE

2nd line

Strength200 mg

Formoral.solid

Adult dose and duration

200-600 mg once daily x 4-6 weeks

Paediatric dose

3-6 mg/kg/day [child max 200 mg]

(3-6 mg/kg once daily for 6 weeks under specialist supervision)

Dose by weight
3kg9-18 mg/day
4kg12-24 mg/day
5kg15-30 mg/day
6kg18-36 mg/day
7kg21-42 mg/day
8kg24-48 mg/day
9kg27-54 mg/day
10kg30-60 mg/day
11kg33-66 mg/day
12kg36-72 mg/day
13kg39-78 mg/day
14kg42-84 mg/day
15kg45-90 mg/day
16kg48-96 mg/day
17kg51-102 mg/day
18kg54-108 mg/day
19kg57-114 mg/day
20kg60-120 mg/day
21kg63-126 mg/day
22kg66-132 mg/day
23kg69-138 mg/day
24kg72-144 mg/day
25kg75-150 mg/day
26kg78-156 mg/day
27kg81-162 mg/day
28kg84-168 mg/day
29kg87-174 mg/day
30kg90-180 mg/day
31kg93-186 mg/day
32kg96-192 mg/day
33kg99-198 mg/day
34kg102-200 mg/day (upper capped)
35kg105-200 mg/day (upper capped)
36kg108-200 mg/day (upper capped)
37kg111-200 mg/day (upper capped)
38kg114-200 mg/day (upper capped)
39kg117-200 mg/day (upper capped)
40kg120-200 mg/day (upper capped)
41kg123-200 mg/day (upper capped)
42kg126-200 mg/day (upper capped)
43kg129-200 mg/day (upper capped)
44kg132-200 mg/day (upper capped)
45kg135-200 mg/day (upper capped)
46kg138-200 mg/day (upper capped)
47kg141-200 mg/day (upper capped)
48kg144-200 mg/day (upper capped)
49kg147-200 mg/day (upper capped)
50kg150-200 mg/day (upper capped)
Dose source

WHO EMRO Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region (2014), p.24, under complex situations

Why

An oral option where the antimonials are not practical. WHO's regional manual is careful about it: the regimen has been proposed for L. major cutaneous leishmaniasis and its efficacy is variable. It sits here as a second choice, which is where that document puts it.

Cautions
  • WHO EMRO records this regimen as one that has been put forward for L. major cutaneous leishmaniasis while noting that how well it works varies, and lists it under complex situations rather than as a first option.
  • Most cutaneous leishmaniasis heals without systemic treatment, leaving a scar. Weigh a six-week azole course against that, particularly for a single small lesion not on the face.
  • Contraindicated in pregnancy.
  • Intralesional or systemic antimonials (meglumine antimoniate) are standard first-line in specialist centers; fluconazole is an oral alternative for L. major.
  • Monitor liver function tests during 6-week course.
Egyptian brands
Egyptian brandManufacturerIndicative price
ACTRIAZOLE 200 MG 2 CAPS.EGPI > RIGHT CARE PHARMA51.50 EGP (25.75/unit)
NAVILUCA 200 MG 7 CAPS.INTERNATIONAL DRUG INDUSTRIES > ROTABIOGEN255.00 EGP (36.43/unit)
FUNGICLEAR 200 MG 2 CAPS.EGPI > HEROPHARM74.00 EGP (37.00/unit)
FUNGICLEAR 200 MG 4 CAPS.EGPI > HEROPHARM148.00 EGP (37.00/unit)
DIFLUNAZOLE 25MG/5ML SYRUP 70ML? strength differs? different route - not oral solidCID28.80 EGP
FLUCAZONIL 25MG/5ML SYRUP 70 ML? strength differs? different route - not oral solidEL NILE.28.80 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.