CANINE LEISHMANIASIS: GUIDELINES FOR DIAGNOSIS, STAGING, THERAPY, MONITORING AND PREVENTION Part II: Therapeutic approach

Guidelines on "Diagnosis, Classification, Therapy, Monitoring and Prevention of Canine Leishmaniasis" are formulated by the Canine Leishmaniasis Working Group (CLING) with the aim to offer to the veterinarian the correct overview on pathophysiology, diagnosis, therapy, and prevention of canine disease caused by Leishmania spp. CLING activity grounds on evidence based medicine; in case of controversies or absence of evidence in veterinary literature, a consensus is reached among the members. These guidelines are intended to veterinarians and are not to be thought as totally exhaustive or unchangeable. The aim of this paper is to provide a tool to use in most conditions but that cannot be able to work out all the issues related to canine leishmaniasis. Guidelines are updated annually based on veterinary literature. Guidelines and their updates are published on "Veterinaria" journal and edited on www.gruppoleishmania.org web-site after their approval by the CLING members. Dogs affected by leishmaniasis are classified in 5 stages: 1) Stage A - exposed; 2) Stage B - infected; 3) Stage C - sick; 4) Stage D - sick with severe clinical signs; 5) Stage E - a: not responsive to therapy; E - b: early relapse. After revision of literature, the consensus was reached for the following therapeutic approach to canine leishmaniasis: 1. Meglumine Antimoniate - Allopurinol combination is the first choice in stage 8, C and D dogs. Meglumine Antimoniate is administered subcutaneously for 4 weeks at, the daily dosage of 100 mg/kg, Allopurinol at the dosage of 10 mg/kg q12h po for at least 4-6 months. Meglumine Antimoniate administration can be divided twice daily (50 mg/kg q12h) and continued up to 8 weeks. 2. An alternative therapeutic approach could be considered in Stage E dogs, using other drugs, when other diseases and concurrent factors (inadequate drug protocol, absence of owner compliance) have been ruled out. 3. Allopurinol administered as single drug at the dosage of 10-20 mg/kg q12h po for at least 3-6 months can be considered an alternative therapeutic approach in all patients presenting contraindications for Meglumine Antimoniate or showing other anti-leishmania drugs side effects. Also, Allopurinol could be suggested when owner compliance is inadequate.