- Miltefosine is the preferred treatment for post-kala-azar dermal leishmaniasis (PKDL) due to its proven oral efficacy, good tolerability, and ability to achieve cure with fewer adverse effects compared to traditional antimonials.
- It offers a convenient oral regimen, improving patient compliance over injectable therapies like sodium stibogluconate.
- Amphotericin B and paromomycin are used mainly in visceral leishmaniasis but are less favored for PKDL because of their toxicity profile and parenteral administration.
- Therefore, miltefosine is the first-line treatment for PKDL given its effectiveness and safety.

Reference: Davidson’s Principles and Practice of Medicine, 24th Edition, Chapter: Infectious Diseases, Page 1063.