Efficacy of azithromycin in the treatment of cutaneous leishmaniasis

Abstract

The present open pilot study was conducted to assess the efficacy of azithromycin for the treatment of patients with cutaneous leishmaniasis in Araçuaí and Varzelândia, MG. Twenty-four patients with less of six months of disease evolution were treated after clinical examination, Montenegro test and a biopsy. The treatment schemes consisted of oral doses of 500 mg per day for 3, 5 and 10 days and of 1000 mg for two days. A clinical control was performed monthly and treatment cycles were repeated when necessary until full reepithelialization of the lesions. On the occasion of the final evaluation, 20 patients had completed the study and 17 of them (85%) were cured. The time to obtain a cure was 60 days ifor 6 (30%) patients, 90 days for 7 (35%), and 120 for 4 (20%). The three patients with treatment failure received a pentavalent antimonial for 20 days. No adverse reactions to the medication were observed and a 14 month follow-up did not show recurrence in any patient. These results suggest that azithromycin can be a good therapeutic option for the treatment of cutaneous leishmaniasis caused by Leishmania Viannia brasiliensis. Key words: Cutaneous leishmaniasis. Azithromycin. Leishmania Viannia brasiliensis.Resumo O presente estudo piloto aberto avaliou a eficácia da Azitromicina em pacientes com leishmaniose cutânea, em Araçuaí e Varzelândia, MG. Foram tratados 24 pacientes após exame clínico, teste de Montenegro, e biópsia, e que tivessem menos de seis meses de evolução da doença. Os esquemas de tratamento empregaram doses, pela via oral, de 500 mg por dia durante 3,5 e 10 dias e de 1000 mg durante dois dias. Mensalmente foi realizado controle clínico e quando necessário, repetidos ciclos do medicamento, até reepitelização completa das lesões. Na avaliação final 20 pacientes terminaram o estudo, dos quais 17 (85%) foram curados. O tempo de cura foi de 60 dias em 6 (30%) pacientes, de 90 dias em 7 (35%) e de 120 dias em 4 (20%). Os três pacientes que tiveram falha terapêutica receberam antimonial pentavalente durante 20 dias. Não foram observadas reações adversas ao medicamento e o seguimento até 14 meses pós-tratamento não mostrou recidiva em nenhum dos pacientes. Estes resultados sugerem que a Azitromicina pode ser uma boa opção terapêutica para o tratamento de leishmaniose cutânea causada por Leishmania Viannia brasiliensis.

Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis

“…Reports from the New and Old World show divergent results, with cure rates of 85% [91] and 27.6% [92], respectively.…”

Comparison between intralesional injection of zinc sulfate 2 % solution and intralesional meglumine antimoniate in the treatment of acute old world dry type cutaneous leishmaniasis: a randomized double-blind clinical trial

“…The first line-therapy for ACL, according to WHO recommendation, is the pentavalent antimony compounds such as meglumine antimoniate (Glucantime) (Minodier and Parola 2007). Other treatments for cutaneous leishmaniasis (CL) are antifungal agents, azithromycin, paromomycin ointment, and physical treatment like cryotherapy (cryosurgery) (Prata et al 2003;Dogra et al 1990;Al majalio and Routh 1997;Esfandiarpour and Alavi 1997). In recent researches ZS has been studied to treat the disease, although there are some controversies regarding the efficacy of ZS in the treatment of cutaneous leishmanniasis (Firooz et al 2004;Iraji et al 2004).…”

Failure of both azithromycin and antimony to treat cutaneous leishmaniasis in Manaus, AM, Brazil

“…In an open trial in Brazil, it cured 16 out of 20 patients with cutaneous ulcers caused by Leishmania (Viannia) braziliensis, however, cure time, doses and cycles number presented high variability (PRATA et al, 2003). In the same location; three out of four old individuals with mucosal involvement presented clinical cure after several cycles with this drug (SILVA-VERGARA et al, 2004).…”