Is Paromomycin an Effective and Safe Treatment against Cutaneous Leishmaniasis? A Meta-Analysis of 14 Randomized Controlled Trials

Abstract

BackgroundHigh cost, poor compliance, and systemic toxicity have limited the use of pentavalent antimony compounds (SbV), the treatment of choice for cutaneous leishmaniasis (CL). Paromomycin (PR) has been developed as an alternative to SbV, but existing data are conflicting.Methodology/Principal FindingsWe searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, without language restriction, through August 2007, to identify randomized controlled trials that compared the efficacy or safety between PR and placebo or SbV. Primary outcome was clinical cure, defined as complete healing, disappearance, or reepithelialization of all lesions. Data were extracted independently by two investigators, and pooled using a random-effects model. Fourteen trials including 1,221 patients were included. In placebo-controlled trials, topical PR appeared to have therapeutic activity against the old world and new world CL, with increased local reactions, when used with methylbenzethonium chloride (MBCL) compared to when used alone (risk ratio [RR] for clinical cure, 2.58 versus 1.01: RR for local reactions, 1.60 versus 1.07). In SbV-controlled trials, the efficacy of topical PR was not significantly different from that of intralesional SbV in the old world CL (RR, 0.70; 95% confidence interval, 0.26–1.89), whereas topical PR was inferior to parenteral SbV in treating the new world CL (0.67; 0.54–0.82). No significant difference in efficacy was found between parenteral PR and parenteral SbV in the new world CL (0.88; 0.56–1.38). Systemic side effects were fewer with topical or parenteral PR than parenteral SbV.Conclusions/SignificanceTopical PR with MBCL could be a therapeutic alternative to SbV in selected cases of the old world CL. Development of new formulations with better efficacy and tolerability remains to be an area of future research.

Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis

“…However, the response to topical paramomycin associated with methylbenzethonium chloride was worse than parenteral pentavalent antimony in treating cutaneous leishmaniasis in the New World. Similar efficacy to Sb V in the treatment of leishmaniasis in the New World was observed when parenteral paramomycin was used to treat New World LCL [90].…”

Polymerase Chain Reaction Detection of Leishmania kDNA from the Urine of Peruvian Patients with Cutaneous and Mucocutaneous Leishmaniasis

“…Although the overall sensitivity of urine PCR for the diagnosis of CL was sub-optimal compared with the very sensitive molecular assays on invasively obtained scrapings and biopsies of cutaneous and mucosal lesions, [1][2][3][4][5] the presence of detectable kDNA in the urine may suggest a potential role in categorizing patients as candidates for different therapies, especially given the over-representation of mucosal disease in the group with detectable kDNA in the urine. Given the toxicity associated with currently used parenteral therapies for CL (such as pentavalent antimonials and amphotericin B), 1 , 25 there is a movement toward use of topical therapies such as paromomycin, [26][27][28][29][30] cryo-or thermotherapy, [31][32][33] or intralesional antimonials. [32][33][34] However, patients with detectable kDNA in urine may represent a group of patients with less localized forms of disease that may be most amenable to systemic therapy.…”

A Rare Skin Lesion During Pregnancy: Localized Cutaneous Leishmaniasis

“…In addition, these are (DAC N-055 is not studied enough for use during pregnancy) acceptable for use during pregnancy and breast feeding. Other local treatment approaches include intralesional pentavalent antimony, topical paromomycin and photodynamic therapy (12)(13)(14). However, our patient was lost to follow-up after delivery, so we were unable to apply and evaluate these treatment modalities.…”