Systemic Meglumine Antimoniate in Acute Cutaneous Leishmaniasis: Children versus Adults

Abstract

Some studies showed that children have a lower response to systemic use of pentavalent antimoniate than adults. We aimed to evaluate the response rate to Glucantime therapy in children and compare it with adults. One hundred and twelve patients with acute cutaneous leishmaniais (ACL) were divided into two equal groups of adults (> 15 yrs) and children (≤ 15 yrs). They received meglumine antimoniate; 20 mg/kg/day for 20 days, their improvement rate was evaluated 20 and 45 days after treatment. Perprotocol analysis showed a significantly lower response in the children group 20 and 45 days after initiation of the treatment (P = 0.0001, 95% confidence interval [CI] = 0.190 [0.079–0.456]/P = 0.0051, 95% CI = 0.317 [0.140–0.717], respectively). Moreover, after intention-to-treat analysis, the same results were seen in the younger group 20 and 45 days after treatment (P = 0.0003, 95% CI = 0.228 [0.098–0.528]/P = 0.0132, 95% CI = 0.382 [0.177–0.825], respectively). According to our results, systemic Glucantime has lower efficacy in treating ACL in children than adults.

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

“…A number of other studies have yielded similar results. Layegh et al showed that systemic Glucantime® has a significantly lower efficacy in treating acute cutaneous leishmaniasis in children than in adults (22). In another study performed on L. viannia species, cutaneous treatment by systemic Glucantime® also had a clinically significant lower response in children when compared with the same regimen dosage and duration in adults (23).…”

Treatment of American tegumentary leishmaniasis in special populations: a summary of evidence

“…The maximum daily dose of SbV for children under 12 years of age must not exceed 121.5mg (7.5ml), and treatment of children under 18 months is not recommended 39 . However, CL treatment with meglumine antimoniate is less effective in children than in adults [40][41][42] . The lower effi cacy may result from the pathogenicity of the parasite or the particular immune response of this age group 40,42 .…”

Old-world leishmaniasis presenting as a nasal mass

“…[5] Leishmaniasis is a diverse and complex disease. Each species can produce more than one clinical form of the disease and each form of the disease could be caused by multiple species.…”

“…L. tropica is capable of surviving in a latent state in previously affected tissues and may have spread after the cutaneous lesion healed. [12] Since mucosal involvement due to old-world leishmaniasis is not frequent and the few reported cases concern immunocompromised patients, [5] we assessed our patient in this respect. He had no signs of immunodeficiency.…”