Aminosidine (paromomycin) versus sodium stibogluconate for the treatment of American cutaneous leishmaniasis

Abstract

The efficacy of aminosidine was compared with sodium stibogluconate in an open, randomized study of parasitologically-proven cutaneous leishmaniasis in Belize. Aminosidine, 14 mg/kg/d (max. 1 g daily) for 20 d, healed 10 of 17 lesions and sodium stibogluconate, 20 mg/kg/d for 20 d, healed 15 of 17 lesions. Lesions caused by Leishmania braziliensis were relatively unresponsive to aminosidine. Aminosidine was well tolerated and toxicity was not observed. Sodium stibogluconate was not well tolerated and treatment was associated with bone marrow suppression and elevation of serum aminotransferases.

Treatment failure in children in a randomized clinical trial with 10 and 20 days of meglumine antimonate for cutaneous leishmaniasis due to Leishmania viannia species.

“…Published efficacy trials of pentavalent antimonial drugs using a regimen of 20 mg Sb/kg/d for 20 days in Colombia and the Americas, have documented an efficacy of 88 to 100% for the treatment of cutaneous leishmaniasis caused by species of the Leishmania Viannia subgenus. 5,8,[13][14][15][16]20 One group in the Colombian southwest and close to our study area, reported efficacy of meglumine antimonate with a 15-day regimen, to be 40%, 21,22 and close to the 36-37% efficacy of placebo reported by other investigators in other areas of Colombia. 8,20 All of these trials have involved young-adult populations primarily.…”

“…The overall low efficacy of pentavalent antimonials in this population and the relationship of age with poor clinical response would not have been detected in the adult male populations usually recruited for efficacy studies. 5,8,13,15,16 This study was designed as a two-arm active-medicine clinical trial because the use of placebo was considered unethical in view of the risk of mucosal or cutaneous relapses reported previously in the area. 17 The results did not reveal significant differences in efficacy between 10 and 20 days of supervised treatment with 20 mg Sb/kg/d.…”

“…A 25% difference was considered clinically significant, taking into account the potential benefits of a 10-day treatment as opposed to 20 days, the high efficacy of pentavalent antimonials reported in the literature for the treatment of New World cutaneous leishmaniasis (88-100%) 5,8,[13][14][15][16] and the 100% cure we obtained in a previous pilot study involving 10 adult patients treated with meglumine antimonate for 10 days (Ochoa MT, unpublished data). The number of participants in the total study population was increased to 136 to compensate for the expected loss to follow-up.…”

Synthesis and biological evaluation of a novel class as antileishmanial agent

“…This finding coincide with that obtained by Hepburn et al (1994) where it was possible that Leishmania present in clinically treated lesion, hence a post treatment culture is useful. This finding has an applicable medical importance, that patient treated with one of antileishmanial drug and showed marked clinical response, should be carefully examined for fear of the presence of viable parasite which may have important consequence if the patient subsequently becomes immunosuppressed.…”

In Vitro Sensitivity of Cutaneous Leishmania Promastigote Isolates Circulating in French Guiana to a Set of Drugs

“…The use of injectable paromomycin is not effective against CL. 19,20 However, its topical use as an ointment cured CL caused by species of the New and Old World, especially when supplemented with gentamicin. [21][22][23][24][25] However, the efficacy may vary.…”