An alternative antimonial schedule to be used in cutaneous leishmaniasis when high doses of antimony are undesirable

Abstract

Despite more than half a century of use in leishmaniasis, antimony therapy still presents serious problems concerning dosage and toxicity. Low and high doses have been shown to be equally effective. In this paper, the feasibility of injecting one ampoule of meglumine antimoniate intramuscularly every other day until clinical cure is demonstrated, while studying a series of 40 cutaneous leishmaniasis cases. Total dose used varied from 1,822.5 to 12,150mg of pentavalent antimony and total time of treatment varied from 3 to 10 weeks, with 86% efficacy. Thirty-six out of the 40 patients are still on follow-up with a mean time of 10.7 ± 7 months and a median of 9 months. No relapse or mucosal lesions have been noted so far. The schedule showed good tolerance and easy application and its efficacy was comparable to the officially recommended WHO schedule. Therefore, such a schedule represents a valuable alternative for the cases with high toxicicity to antimony or daily injections are an obstacle to the treatment. Key-words: Cutaneous leishmaniasis. Pentavalent antimony. Low dose. Systemic therapy. RESUMOApesar de utilizado há mais de meio século no tratamento da leishmaniose, o antimônio apresenta ainda problemas quanto a sua toxicidade e dose ideal. Doses baixas têm se mostrado tão eficazes quanto doses altas. Neste trabalho, apresentamos o resultado do emprego de uma ampola de antimoniato de meglumina intramuscular, em dias alternados, até a cura clínica, numa série de 40 casos. A dose total utilizada, por paciente, variou de 1.822,5 a 12.150mg de antimônio pentavalente e o tempo de tratamento de 3 a 10 semanas com eficácia de 86%. Dos 40 pacientes estudados, 36 ainda estão em acompanhamento, com um tempo médio de 10,7 + 7 meses e média de 9 meses. Não houve recidivas nem lesões mucosas. O esquema utilizado foi bem tolerado, de fácil aplicação, eficácia comparável ao esquema oficialmente preconizado pela OMS, mostrando-se como valiosa alternativa para os casos com potencial toxicidade ao antimônio ou cuja aplicação de injeções diárias represente um obstáculo ao tratamento. Palavras-chaves: Leishmaniose cutânea. Antimônio pentavalente. Baixa dose. Tratamento sistêmico.

Antimony in plasma and skin of patients with cutaneous leishmaniasis – relationship with side effects after treatment with meglumine antimoniate

“…Few studies describe the occurrence of side effects in patients receiving antimonial doses different than the conventional protocol. In a study with 40 patients receiving intramuscularly one ampoule of Glucantime ® (405 mg of antimony)/day on alternate days, up to clinical cure, only six reported side effects, mainly pain at the injection site, slight arthralgia and nausea (Oliveira‐Neto & Mattos 2006). Oliveira‐Neto et al.…”

CpG ODN D35 improves the response to abbreviated low-dose pentavalent antimonial treatment in non-human primate model of cutaneous leishmaniasis

“…Lastly, there are growing reports in India, Iran, and Peru of emerging resistance to antimonials in the field [10][11][12][13][14]. Several studies have explored reducing the dose or shortening the course of antimonial treatment to improve compliance and reduce toxicities with limited success [15,16].…”

Clinical and laboratory profiles of patients with early spontaneous healing in cutaneous localized leishmaniasis: a historical cohort study

“…Studies in Latin America show significant differences in cure rates with pentavalent antimony (PA) [3, 6, 8, 22–24]. It has also been reported that early treatment of ACL does not prevent the development of ulcers [25, 26] and is associated with higher treatment failure rates [26].…”