What medication serves as the first-line treatment for visceral leishmaniasis?

Liposomal amphotericin B is considered the first-line treatment for visceral leishmaniasis due to its effectiveness and favorable safety profile compared to other options. This formulation of amphotericin B is designed to reduce the toxicity typically associated with conventional amphotericin B, such as renal impairment and infusion reactions. It works by binding to ergosterol in the fungal cell membrane, which alters membrane permeability, ultimately leading to cell death.

The use of liposomal amphotericin B has significant clinical evidence supporting its efficacy in treating visceral leishmaniasis, particularly given the rising resistance to other treatments and the serious nature of the disease, which can lead to significant morbidity and mortality if left untreated.

While other medications such as Miltefosine are used as alternative treatments, especially in certain populations and geographical areas, they do not have the same level of universal application or established first-line status as liposomal amphotericin B. Albendazole and azole antifungals are not appropriate for this specific condition, as they target different types of infections and do not exhibit the effectiveness needed against leishmaniasis.