Oral miltefosine (2.5 mg/kg/d for 28 days) was compared with intramuscular antimony (20 mg/kg/d for 20 days) in the treatment of cutaneous leishmaniasis caused by Leishmania braziliensis in Palos Blancos, Bolivia. The cure rates with 6 months of follow-up were statistically similar: 36 of 41 evaluable miltefosine patients (88%) versus 15 of 16 (94%) evaluable antimony patients. However, antimony cured more rapidly, because, by 1 month after therapy, 31 of 44 miltefosine patients (70%) compared with 16 of 16 antimony patients (100%) had achieved cure. The two conclusions from this work are that oral miltefosine can be used for cutaneous disease in this part of Bolivia and that miltefosine was more effective for L. braziliensis in this region than for L. braziliensis in Guatemala. Chemotherapy needs to be evaluated in each endemic region, even if the "same" species of Leishmania causes disease in these locales.

We investigated whether increasing the period of follow-up or increasing the duration of therapy would markedly alter the 71% cure rate of mucosal leishmaniasis in Bolivia consequent to treatment with miltefosine for 4 weeks. Increasing the follow-up from 12 months to 24 months demonstrated additional relapse in only 2 of 41 patients. Increasing the period of therapy from 4 weeks to 6 weeks only increased the cure rate to 75%. The cure rate of mucosal leishmaniasis in Bolivia, whether 4 or 6 weeks of therapy is used and whether 12 month or 24 months follow up is conducted, is approximately 70%.