Visceral leishmaniasis (VL) causes an estimated 500,000 new cases of disease and more than 50,000 deaths a year. For more than 60 years, pentavalent antimonies were considered the standard therapy for VL. The emergence of Leishmania strains resistant to antimonials led to the evaluation of other treatments including amphotericin B and its lipidic derivatives. Clinical trials with liposomal amphotericin B demonstrated that total doses of 10 to 20mg/kg, administered according to various regimens, had a 90-98% efficacy in non-immunocompromised patients. Compared to antimonials, liposomal amphotericin B provides favorable efficacy/tolerance and cost efficacy ratios. The WHO recently produced consensus recommendations for the use of liposomal amphotericin B in VL. In Europe, liposomal amphotericin B has progressively become the reference treatment of VL in clinical practice, and it is recommended as the first line therapy.