What is the role of topical paromomycin 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

Topical paromomycin has been shown to be effective against cutaneous leishmaniasis caused by L major and L mexicana. Because these species do not tend to cause visceral or mucocutaneous disease, topical paromomycin can spare the patient systemic adverse effects associated with parenteral medications. Topical therapy is not recommended for treatment of New World species that are known to progress to mucocutaneous disease.

In a randomized, double-blind, parallel group–controlled study in 375 patients from a region of Tunisia where leishmaniasis is endemic, Ben Salah et al demonstrated that paromomycin topical cream, with or without gentamicin, was effective against ulcerative cutaneous leishmaniasis. [47, 48] Study subjects received 15% paromomycin, 15% paromomycin plus 0.5% gentamicin, or vehicle control (containing neither gentamicin nor paromomycin). After 20 days of treatment, paromomycin alone achieved a cure rate of 82%, paromomycin-gentamicin achieved a cure rate of 81%, and vehicle control achieved a cure rate of 58%. [47, 48]

An ointment that contains 15% paromomycin and 12% methylbenzethonium chloride showed an even higher cure rate of 87% after 20 days of topical treatment for cutaneous L major. [49] Unfortunately, the performance of this cream with infections caused by L tropica has been disappointing.

Although topical paromomycin is not commercially available in the United States, this cream may be available from compounding pharmacies and is used in Israel for the treatment of L major lesions.


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