However, the procurement and prolonged IV or IM administration of these drugs is procedurally difficult, especially in third world countries where the disease is most prevalent. Other antibiotics that have been tried with limited success include pentamidine, amphotericin B, ketoconazole, and allopurinol. New amphotericin B formulations are major advances in treatment during the last decade. They are used in cases resistant to antimonials and are less toxic than they historically have been. Antiparasitic - Therapy must cover all likely pathogens in the context of the clinical setting.
Children often tolerate the therapy better than adults do.
New lipid associated formulations are taken up well by the reticuloendothelial system, and poorly by the kidney. These formulations target the cells that host the parasite and have decreased nephrotoxicity. Dosages depend on type of amphotericin B used, as well as type of leishmaniasis. Clinical protocols are evolving. Nonspecific measures, such as local heat and cleanliness, contribute to the spontaneous healing of the ulcers.