Early enlargement of an ulcerated area during leishmaniasis treatment with meglumine antimoniate in Brazil

Romero, Gustavo Adolfo Sierra; Molinet, Felix Javier Leon; Noronha, Elza Ferreira

doi:10.1093/trstmh/trt002

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…The ulcers, after a period of ten days, began to show remarkable inflammatory signs associated with intense pain, increased size and, in some cases the lymphatic spread of the disease ( Fig 3 ). The early enlargement of the ulcers during treatment with meglumine antimoniate was previously reported, but the intensity of inflammatory signs and the concomitant lymphatic involvement constitutes a novel finding never reported in patients with leishmaniasis exposed to fluconazole [ 40 ].…”

Section: Discussionmentioning

confidence: 98%

Failure of fluconazole in treating cutaneous leishmaniasis caused by Leishmania guyanensis in the Brazilian Amazon: An open, nonrandomized phase 2 trial

Francesconi

Ramasawmy

et al. 2018

PLoS Negl Trop Dis

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BackgroundThe treatment of Leishmaniasis caused by Leishmania (Viannia) guyanensis is based on a weak strength of evidence from very few clinical trials and some case series reports. Current treatment guidelines recommend pentamidine isethionate or meglumine antimoniate (Glucantime) as the first-line choices. Both are parenteral drugs with a low therapeutic indexes leading to a high risk of undesired effects. Imidazole derivatives interfere with the production of leishmanial ergosterol, an essential component of their membrane structure. One drug that has been studied in different clinical presentations of Leishmania is fluconazole, a hydrophilic bis-triazole, which is easily absorbed through the oral route with a low toxicity profile and is considered safe for children. This drug is readily available in poor countries with a reasonable cost making it a potential option for treating leishmaniasis.Methods and findingsAn adaptive nonrandomized clinical trial with sequential groups with dose escalation of oral fluconazole was designed to treat adult men with localized cutaneous leishmaniasis (LCL) in Manaus, Brazil. Eligible participants were patients with LCL with confirmed Leishmania guyanensis infection.ResultsTwenty adult male patients were treated with 450 mg of fluconazole daily for 30 days. One patient (5%) was cured within 30 days of treatment. Of the 19 failures (95%), 13 developed a worsening of ulcers and six evolved lymphatic spreading of the disease. Planned dose escalation was suspended after the disappointing failure rate during the first stage of the trial.Conclusion/SignificanceOral fluconazole, at the dose of 450mg per day, was not efficacious against LCL caused by Leishmania guyanensis in adult men.Trial registrationBrazilian Clinical Trial Registration (ReBec)—RBR-8w292w; UTN number—1158-2421

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Section: Discussionmentioning

confidence: 98%

Failure of fluconazole in treating cutaneous leishmaniasis caused by Leishmania guyanensis in the Brazilian Amazon: An open, nonrandomized phase 2 trial

Francesconi

Ramasawmy

et al. 2018

PLoS Negl Trop Dis

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“…The pentavalent antimonybased drugs meglumine antimoniate (Glucantime®) and sodium stibogluconate (Pentostam®, GlaxoWellcome) or generic sodium stibogluconate (Albert David Ltd, India) are the first line of treatment against both New World and Old World types of cutaneous leishmaniasis (8)(9)(10). However, increasing resistance of Leishmania spp.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of meglumine antimoniate against L. tropica in a recently emerged focus of cutaneous leishmaniasis in Birjand, eastern Islamic Republic of Iran

Karamian

Bojd

Salehabadi

et al. 2015

Easter Mediterr Health J

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With limited options to treat cutaneous leishmaniasis, constant monitoring of the rate of resistance to pentavalent antimony-based drugs is needed. This study identified the infecting Leishmania species and evaluated the results of meglumine antimoniate (Glucantime®) therapy in a new focus of cutaneous leishmaniasis in Birjand, eastern Islamic Republic of Iran. Smears from 150 patients showed that 141 patients were infected by L. tropica and 9 by L. major. In total, 141 patients with L. tropica infection completed Glucantime® treatment and follow-up; 63.8% were treated intralesionally and 36.2% by intramuscular administration. The overall success rate after one course of therapy with Glucantime ® was 96.5% (136/141), and all the failures (5/141) occurred with intramuscular injections. Statistical analysis showed a significant difference between the failure rates of intramuscular and intralesional injections. Children < 10 years old had a significantly higher failure rate than adults.

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Early enlargement of an ulcerated area during leishmaniasis treatment with meglumine antimoniate in Brazil

Cited by 2 publications

References 15 publications

Failure of fluconazole in treating cutaneous leishmaniasis caused by Leishmania guyanensis in the Brazilian Amazon: An open, nonrandomized phase 2 trial

Failure of fluconazole in treating cutaneous leishmaniasis caused by Leishmania guyanensis in the Brazilian Amazon: An open, nonrandomized phase 2 trial

Effectiveness of meglumine antimoniate against L. tropica in a recently emerged focus of cutaneous leishmaniasis in Birjand, eastern Islamic Republic of Iran

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