Liposomal amphotericin B in comparison to sodium stibogluconate for cutaneous infection due to Leishmania braziliensis.
BACKGROUND
New World cutaneous leishmaniasis among Israeli travelers is mostly acquired in the Amazon Basin of Bolivia where Leishmania viannia (V.) braziliensis is endemic. Treatment with systemic pentavalent antimonial compounds is effective in achieving clinical cure in only 75% of cases. In this study, we assessed liposomal amphotericin B (AmBisome) as an alternative treatment for cutaneous L (V.) braziliensis infection.


METHODS
A prospective evaluation was performed for cutaneous leishmaniasis due to L (V.) braziliensis, proven by polymerase chain reaction. A 3-mg/kg AmBisome dose was given for 5 consecutive days, and a sixth dose on day 10, all in an outpatient setting. This therapy was compared with a series of historical patients who were treated with sodium stibogluconate (SSG).


RESULTS
Seven consecutive patients, 5 males and 2 females, received AmBisome treatment. All were returned travelers infected in Bolivia; their mean age was 23.1 years; 5 had failed to respond to a full course of SSG; two had a primary lesion; none had mucosal lesions. All achieved complete clinical cure within less than 1 month. Mean follow-up of 12 months revealed no relapses. Side effects were mild, and none had to terminate treatment prematurely. Comparison of AmBisome to SSG treatment shows that the former is safer, with fewer recurrence rates. Additionally, the expense of the total care with AmBisome is less than with SSG: 45% less if SSG was given in an inpatient setting; 15% less when SSG was given in an outpatient setting.


CONCLUSIONS
This was a nonrandomized study, with relatively few patients.


CONCLUSIONS
AmBisome treatment for L (V.) braziliensis appears to be effective, better tolerated, and to have more cost benefit in countries where hospital-care costs are significant.
Solomon
Michal
M
Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Baum
Sharon
S
Barzilai
Aviv
A
Scope
Alon
A
Trau
Henry
H
Schwartz
Eli
E
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D000818:Animals; D000967:Antimony Sodium Gluconate / Q000008:administration & dosage*; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007892:Leishmania braziliensis / Q000187:drug effects* / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012874:Skin Diseases, Infectious / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate