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

Abstract

Revista da Sociedade Brasileira de Medicina Tropical 46(6):669-677, Nov-Dec, 2013http://dx.doi. org/10.1590/0037-8682-0104-2013 Address to: Dr a Juliana Saboia Fontenele e Silva. Lab. ABSTRACT We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fi ll in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.

Risk factors for therapeutic failure to meglumine antimoniate and miltefosine in adults and children with cutaneous leishmaniasis in Colombia: A cohort study

“…Allometric dosing of miltefosine have been proposed as an alternative to improve drug exposure in children, and its safety is being evaluated currently for VL patients (NCT02431143 and NCT02193022); however, little is known about feasibility or safety of alternative dosing regimens for antimonials. Despite these facts, meglumine antimoniate is still the first line treatment in all age groups in Colombia, which highlights the urgent need to reconsider the management of pediatric cutaneous leishmaniasis with improved dosing or alternative treatments [26]. …”

Clinical, laboratory, and therapeutic characteristics of American tegumentary leishmaniasis in the 15 th State Health Division, Northwest Paraná State, Southern Brazil

“…In previous studies in Paraná State, Silveira et al (7) , Castro et al (8) , and Curti et al (14) reported a higher prevalence of ATL in patients aged 15-49 years, whereas Pontello et al (17) reported an associated age of 21-40 years. According to Silva et al (18) , the ATL incidence in individuals aged >65 years has increased significantly in Brazil. In fact, in the present study, 19.5% of the patients were aged >60 years and 6 deaths occurred in individuals aged ≥59 years, including 1 registered in the SINAN as due to ATL.…”

Clinical Pharmacokinetics of Systemically Administered Antileishmanial Drugs

“…Treatment options for pregnant women are particularly limited in leishmaniasis patients. The use of pentavalent antimonials, pentamidine and miltefosine is contraindicated in pregnancy (FDA categories C, C and D, respectively), and thus the only treatment options are paromomycin (no category assigned) and AMB (FDA category B) (reviewed in Fontenele e Silva et al [ 112 ]). The physiological changes in pregnant women are known to possibly alter the ADME of drugs and could thus potentially affect the exposure to drugs.…”