Retrospective study of 151 patients with cutaneous leishmaniasis treated with meglumine antimoniate

Abstract

We retrospectively analyzed a series of 151 cases of cutaneous leishmaniasis treated between 1967 and 1982. One-hundred-and-thirty-nine (92%) patients presented with active lesions and were treated with daily doses of meglumine antimoniate: 81 adults received a 5-ml vial IM and 58 children received 1 to 5ml. Forty-five (32.4%) patients underwent continuous treatment with meglumine antimoniate for 25 to 116 days without rest intervals, and 94 (67.6%) intermittent treatment with 2 to 5 series of meglumine antimoniate. Intermittent series could include schedules of daily IM applications for 10 to 25 days each and intervals varying from 10 to 60 days. Antimony dose was calculated for 66 (47.5%) patients and ranged from 3.9 to 28.7 Sb5+/kg/day. Of these, 35 patients received >10mg and 31 patients <10mg Sb5+/kg/day. Median time of healing was longer for lesions on the legs and feet - 67.5 days versus 48.7 days (p < 0.001) for other sites. However, there were no significant differences in the median time of healing between adults and children, intermittent and continuous regimens or high and low antimony doses. Fifty-one patients were reassessed 5 to 14 years after treatment and showed no evidence of disease. These results support further investigation (clinical trials) on treatment using low doses of antimony.

Intralesional Meglumine Antimoniate for Treatment of Cutaneous Leishmaniasis Patients with Contraindication to Systemic Therapy from Rio de Janeiro (2000 to 2006)

“…One patient had no description of lesion site. These results were in disagreement with those of Schubach and others 9 in IL TTM, and Marsden and others 10 in IM TTM. Among eight patients with lesions in lower limbs, seven (87.5%) healed exclusively with IL TTM; and five (62.5%) did not reactivate the lesions.…”

Risk factors associated with dizziness during treatment of mucosal leishmaniasis with meglumine antimoniate: 16-year retrospective study of cases from Rio de Janeiro, Brazil

“…[5][6][7][8][9] At the Laboratory of Leishmaniasis Surveillance, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, we have found continuous or intermittent intramuscular administration of meglumine antimoniate at a dose of 5 mg/kg/day to be effective and well tolerated. [10][11][12][13][14][15] The main side effects of treatment with pentavalent antimonials are myalgia, arthralgia, electrocardiographic Q-T interval prolongation, renal failure and pancreatitis accompanied by elevated lipase levels, among others. 7,11,13,16,17 Older individuals are more affected by mucosal leishmaniasis and also more prone to the side effects of treatment, 13 in addition to presenting other risk factors for the occurrence of dizziness.…”

An alternative antimonial schedule to be used in cutaneous leishmaniasis when high doses of antimony are undesirable

“…In contrast, one of the patients who did not achieve cure was submitted to the conventional high dose therapy and had to be hospitalized to treat severe arthralgias. It was noticeable that cure was achieved with a much smaller dose than that recommended by the WHO, at least in Rio de Janeiro State 8 . It also seems evident that this goal was achieved due to the prolongation of the administration period.…”