What are the cure rates of different regimens for the treatment of 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

Cure rates for pentavalent antimony are 90-97% with 1-3 full intravenous treatment courses; however, the drawbacks are considerable. These drugs are expensive and difficult to obtain. They must be delivered parenterally, they have numerous adverse effects, they may have lot-to-lot variability, and they are becoming increasingly less effective because of the emergence of drug-resistant parasites (especially in certain countries such as India). Interferon-gamma plus antimony may be an alternative option with an acceptable cure rate.

In other parts of the world, intralesional injections have shown promise with less toxicity (although with much lower patient tolerability owing to the pain associated with the intralesional injections).

Alternative treatment regimens with acceptable cure rates but that are not FDA approved for treating selected cases of leishmaniasis are parenteral agents pentamidine and amphotericin B deoxycholate, as well as oral agents ketoconazole, itraconazole, and fluconazole. [2]

However, although much has been made of the use of azoles for the Iraqi L major cutaneous disease, few practitioners in the field believe this is a prudent consideration for routine treatment of this disease. Liposomal amphotericin B has been used with good success in the treatment of cutaneous disease from many parts of the world and is gaining increased acceptance with many practitioners.

Although paromomycin also has acceptable cure rates, it is not available in the US or potentially available only through specific channels. [2]


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