What is the role of oral miltefosine in the treatment of cutaneous leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Treatment of New World cutaneous leishmaniasis has met with variable levels of success. In a randomized controlled trial from Brazil, miltefosine used alone was significantly better than parenteral stibogluconate in older children and adults. [45] In Colombia, miltefosine treatment cured 91% of infections involving L (Viannia) panamensis, similar to antimony therapy, while curing only 53% of infections involving L (Viannia) braziliensis in Guatemala, well below historic antimony cure rates.

However, another study in Bolivia showed oral miltefosine given for 28 days yielded an 82% cure rate compared with 88% for intramuscularly administered meglumine antimonate against L (Viannia) braziliensis. [46] The tolerance for oral miltefosine was so superior to intramuscularly administered meglumine antimonate that the researchers were unable to convince local treating physicians to continue treating the control group with the intramuscular therapy.


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