By: IPP Bureau
Last updated : July 29, 2026 2:00 pm
New recommendations especially for Africa and South-East Asia introduce SSG-free therapies, improve treatment for visceral leishmaniasis and PKDL
The World Health Organization (WHO) has released updated treatment guidelines for visceral leishmaniasis (VL), commonly known as kala-azar, and post-kala-azar dermal leishmaniasis (PKDL), recommending shorter, safer and more patient-friendly treatment regimens for eastern Africa and South-East Asia.
The revised guidelines introduce new therapies for primary VL, PKDL and relapse management in immunocompetent patients, while also updating the safety profile and dosing recommendations for the oral drug miltefosine.
Kala-azar, transmitted through the bite of infected sandflies, is among the world's deadliest parasitic diseases after malaria. The disease is endemic in around 80 countries, with an estimated 50,000 to 90,000 new cases annually, although only 25–45 per cent are reported to WHO.
PKDL, a skin condition that can develop after treatment for kala-azar, is not life-threatening but can serve as a reservoir for infection and is associated with significant social stigma and mental health challenges.
Under the revised recommendations, WHO has, for the first time, endorsed sodium stibogluconate (SSG)-free treatment regimens for eligible patients. In eastern Africa, WHO now recommends oral miltefosine in combination with paromomycin injection for treating both VL and PKDL.
The new regimen shortens treatment to 14 days, reduces the number of injections and lowers treatment-related toxicity compared with the previous 17-day SSG-based regimen.
For South-East Asia, WHO recommends shorter combination therapies using liposomal amphotericin B, either alone or in combination with oral miltefosine, for patients with PKDL. The guidelines also provide clearer recommendations for managing relapsed VL cases in the region.
According to WHO, nearly half of all primary VL patients and all PKDL patients could benefit from the updated treatment recommendations, while patients ineligible for miltefosine-based therapy in Africa will continue to receive older treatment regimens until additional options become available.
Dr Daniel Ngamije Madandi, Director of Malaria and Neglected Tropical Diseases at WHO, said, "These new WHO guidelines mark a turning point. By recommending safer, shorter and more patient-friendly regimens, we are not just improving care; we are accelerating our fight to eliminate this devastating disease and offering renewed hope to communities across Africa and Asia."
Many of the therapies included in the updated recommendations were developed by the Drugs for Neglected Diseases initiative (DNDi) and its partners.
Dr Fabiana Alves, Leishmaniasis-Mycetoma Cluster Director at DNDi, said, "We are delighted that more patient-friendly treatments developed with our partners have been recognized in the WHO guidelines. These advances are important steps towards elimination, but we are already looking ahead. We are now working with Novartis on the development of LXE408, a promising new oral candidate that could help us soon finally move away from injectable regimens."
Countries affected by VL and PKDL are expected to revise their national treatment protocols in line with the new WHO recommendations.
Wyckliff Omondi, Head, Division of Vector Borne & Neglected Tropical Diseases at Kenya's Ministry of Health, said, "Now that the WHO has updated its treatment guidelines, we are working also to include the new treatments in our national guidelines, so our patients can benefit from them as soon as possible."