Efeito de uma formulação hidrofílica de paromomicina tópica na leishmaniose cutânea em pacientes com contra-indicações de tratamento com antimonial pentavalente

Abstract

Revista da Sociedade Brasileira de Medicina Tropical 41(5):444-448, set-out, 2008 ARTIGO/ARTICLEO tratamento ambulatorial da leishmaniose tegumentar no Brasil, realizado com o antimoniato de meglumina (AM) durante 20 a 30 dias, apresenta toxicidade relativamente freqüente. Os efeitos mais relevantes são mialgias, artralgias, anorexia, febre, alterações eletrocardiográficas e alterações bioquímicas da função hepática, renal e pancreática e impedem a aplicação segura em pessoas com ABSTRACTThe therapeutic effect of and adverse events associated with topical use of 10% paromomycin gel on cutaneous leishmaniasis are described. Fifteen patients with cutaneous leishmaniasis fulfilled the following inclusion criteria: contraindication for the use of meglumine antimoniate, positive Montenegro skin test and up to four ulcerated lesions. The formula was prescribed twice a day for 20 days. Fourteen patients were available for the therapeutic outcome evaluation. The cure rate was 21.4% (3/14); 50% improved as far as complete epithelialization; and the failure rate was 28.6%. Nine patients who did not initially present cure were retreated. Eight received a new series of topical paromomycin and one was treated with meglumine antimoniate. Two patients did not receive any new treatment and had continuous slow improvement. Five out of the eight patients retreated with topical paromomycin achieved clinical cure, and three presented failure, including one patient who had shown any improvement with the first treatment. For 53.3% of the patients, the adverse events were mild and local and never led to treatment suspension.

In vitro interaction between paromomycin sulphate and four drugs with leishmanicidal activity against three New World Leishmania species

“…The choice of paromomycin as the fixed drug was based on the following factors: reported clinical antileishmanial activity of this drug against cutaneous and visceral leishmaniasis caused by Old World Leishmania species; 4,5,7 -9 the scarce reports of this drug in Latin America; and the feasibility of topical formulations of this drug for the treatment of cutaneous leishmaniasis, caused by New World species, that might be used in combination with systemic drugs. 10,11…”