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# Antileishmanials

Drugs against Leishmania: injected meglumine antimoniate and oral miltefosine treat the cutaneous and mucosal forms that are common in Colombia.

Updated 2026-11-01

## What they are

Drugs against Leishmania amastigotes living inside macrophages. In the Americas cutaneous leishmaniasis predominates (in Colombia mostly Viannia species such as L. panamensis and L. braziliensis), and it can spread to the mucosa.

## Mechanism of action

Each group works differently: pentavalent antimonials are reduced to trivalent antimony, which drains the parasite's thiols and inhibits trypanothione reductase; miltefosine disturbs membrane lipids and signalling; amphotericin B binds ergosterol; pentamidine and paromomycin have other targets.

Target: Trypanothione reductase and thiols (antimonials); membrane lipids (miltefosine)

## Key points

- Colombia, cutaneous leishmaniasis: meglumine antimoniate IM or IV, or oral miltefosine; in children above a set weight miltefosine is preferred.
- Visceral leishmaniasis: liposomal amphotericin B is first line; antimonials and pentamidine are second line.
- Antimonials: cardiotoxicity (long QT), chemical pancreatitis and raised transaminases; ECG and labs before and during.
- Miltefosine: teratogenic; pregnancy test and contraception during and for months after.
- In pregnancy antimonials, pentamidine and miltefosine are not used; if urgent, liposomal amphotericin B.

## Drugs in this class

- [**Meglumine antimoniate** Injectable pentavalent antimonial, the mainstay for cutaneous leishmaniasis in Colombia; heart, pancreas and liver are… Leishmania trypanothione reductase (and the parasite's thiols)](https://durgical.com/en/pharmacology/meglumine-antimoniate/)
- [**Miltefosine** The only oral antileishmanial: it treats cutaneous, mucosal and visceral leishmaniasis, but it is teratogenic and… Leishmania membrane lipids and signalling](https://durgical.com/en/pharmacology/miltefosine/)

## Others in the class

- Sodium stibogluconate
- Liposomal amphotericin B
- Pentamidine isethionate
- Paromomycin

## Test yourself

Think of the answer, then tap the question to see it.

## What is first-line treatment for visceral leishmaniasis in the Colombian guidance?

Liposomal amphotericin B; pentavalent antimonials and pentamidine are second line.

## Which test is done before antimonials in people over 45 or with heart disease?

An electrocardiogram, because antimonials can prolong the QT interval and cause arrhythmias.

## What is the only oral antileishmanial and its main limitation?

Miltefosine; its main limitation is that it is teratogenic.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Lineamientos de atención clínica integral para Leishmaniasis en Colombia](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/PAI/Lineamientos-leishmaniasis.pdf) (Ministerio de Salud y Protección Social (Colombia), 2023); [Clinical Care of Leishmaniasis](https://www.cdc.gov/leishmaniasis/hcp/clinical-care/index.html) (Centers for Disease Control and Prevention (CDC), 2024); [Leishmaniasis](https://www.who.int/news-room/fact-sheets/detail/leishmaniasis) (World Health Organization, 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 67 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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