Treatment of cutaneous leishmaniasis with itraconazole. Randomized double-blind study

Background: Cutaneous leishmaniasis is an endemic disease in developing countries. The first-line drugs for its treatment are the pentavalent antimony compounds such as meglumine antimoniate (MA). High cost, side effects, multiple injections and incomplete efficacy are limitations of this therapy. Zinc sulfate (ZS) has been reported to be effective in the treatment of cutaneous leishmaniasis. Objective: To compare the efficacy of intralesional injections of ZS 2% with those of MA in the treatment of cutaneous leishmaniasis. Methods: This was a prospective, double-blind, case-control clinical study. 104 patients with typical lesions of acute cutaneous leishmaniasis (ACL) were included. The duration of treatment was 6 weeks. Improvement was evaluated by clinical examination and direct smear. Results: The study was completed in only 66 patients: 35 patients received MA and 31 received ZS. The cure rates were 60% for MA and 83.8% for ZS. After the second and fourth weeks, the efficacy of treatment with ZS was higher than that with MA (p < 0.01), but after 6 weeks no significant differences were observed between the two groups (p > 0.05). Conclusion: On the basis of this trial and despite the high number of drop-outs, we consider that the intralesional injection of ZS 2% is an alternative treatment in ACL.

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“…were not done in this study, but due to a previous study in this area [12], it is most probable that our patients were infected with L. major .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Intralesionally Injected Zinc Sulfate with Meglumine Antimoniate in the Treatment of Acute Cutaneous Leishmaniasis

et al. 2004

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“…entsprach den Angaben in der dermatologischen Fachliteratur, wobei die Dosierung mit 200 mg/d niedrig gewählt war. Andererseits gibt es Publikationen, nach denen Azolantimykotika bei Leishmaniosen unabhängig von der Dosierung von zweifelhaftem Wert sind [4,5].…”

Section: Diskussionunclassified

Kutane Leishmaniose – Import aus Belize

Schnedl¹,

Auer

Fischer

et al. 2007

Wien Klin Wochenschr

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Cutaneous leishmaniasis of the New World, in particular when caused by Leishmania (L.) braziliensis, harbours the risk of lymphogenic as well as hematogenic dissemination. This may result in mucocutaneous leishmaniasis causing severe destruction of orofacial structures. Dissemination may occur years after the disappearance of the skin lesions. In contrast, cutaneous leishmaniasis of the old world, is typically restricted to the site of inoculation. Therefore, a conservative diagnostic and therapeutic approach is usually sufficient. Infections acquired in the new world should be treated systemically, if infection with Leishmania (Viannia) braziliensis complex cannot be excluded. Here we report on three Austrian soldiers, who, weeks after having participated in an international jungle patrol course in Belize, presented themselves with multiple ulcers on the upper limbs. Diagnosis of cutaneous leishmaniasis was made based upon histological evaluation of biopsies taken from several ulcers revealing the presence of leishmanial bodies, and detection of amastigote leishmania in smears of material obtained from the ulcers. As species phenotyping could not be performed, infection with L. brasiliensis as well as progression into a mucocutaneous form were possible, demanding systemic therapy. Several treatment options including local cryotherapy with liquid nitrogen, paromomycin (Humatis Pulvis, Parke-Davis) 15% topically or oral fluconazole (Diflucan, Pfizer) 200 mg/d were applied, but showed no effect. Hence, a systemic therapy with intravenous pentamidine (Pentacarinat, Gerot), three times in total, 3-4 mg/kg body weight each, led to a complete regression of the lesions within four weeks.

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“…In contrast, results obtained with itraconazole are less satisfactory. The following cure rates were obtained in randomized trials conducted in dierent regions: Colombia: 5% [24], Guatemala: 53% (Arana et al, in preparation), India: 80% [7], Iran: 59% [16], and Kuwait: 73% [1].…”

Section: Antifungal Agentsmentioning

confidence: 99%

Chemotherapy of cutaneous leishmaniasis: a review

Arana

Rizzo

Díaz

2001

Med Microbiol Immunol

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A wide variety of treatment modalities have been employed for cutaneous leishmaniasis (CL); however, none has been demonstrated to be good enough to be used as the first-line drug to treat patients in all the CL epidemiological scenarios. Although pentavalent antimonials remain a drug widely used in the treatment of all forms of leishmaniasis, they are far from being satisfactory. A great variety of topical treatments have been used to treat CL. However, the majority of these modalities have been tested in non-controlled studies, with only few subjects and the interpretation of results is usually difficult due to the lack of a standard and well-accepted cure definition. Several oral drugs, such as ketoconazole and itraconazole, have also been tested for CL, but results obtained were not completely satisfactory. As of today, miltefosine, originally developed as an oral antineoplastic agent, seems, from the preliminary results obtained in different phase II clinical studies, to be the most promising oral drug developed during the last decade.

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Treatment of cutaneous leishmaniasis with itraconazole. Randomized double-blind study

Cited by 37 publications

References 0 publications

Comparison of Intralesionally Injected Zinc Sulfate with Meglumine Antimoniate in the Treatment of Acute Cutaneous Leishmaniasis

Comparison of Intralesionally Injected Zinc Sulfate with Meglumine Antimoniate in the Treatment of Acute Cutaneous Leishmaniasis

Kutane Leishmaniose – Import aus Belize

Chemotherapy of cutaneous leishmaniasis: a review

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