title: A species-specific approach to the use of non-antimony treatments for cutaneous leishmaniasis.
abstract: We used a species-specific approach to treat 10 patients with cutaneous leishmaniasis diagnosed using polymerase chain reaction. Non-antimony treatments (oral miltefosine, ketoconazole, and liposomal amphotericin B) were chosen as an alternative to pentavalent antimony drugs based on likely or proven drug efficacy against the infecting species. Leishmania Viannia panamensis was diagnosed in three patients and treated successfully with oral ketoconazole. Miltefosine treatment cured two patients with L. infantum chagasi. A wide variety of Leishmania responded to liposomal amphotericin B administered for 5-7 days. Three patients with L. V. braziliensis, one patient with L. tropica, and two patients with L. infantum chagasi were treated successfully. One person with L. V. braziliensis healed slowly because of a resistant bacterial superinfection, and a second patient with L. infantum chagasi relapsed and was retreated with miltefosine. These drugs were reasonably well-tolerated. In this limited case series, alternative non-antimony-based regimens were convenient, safe, and effective.
authors.affiliation: Clinical Parasitology Unit and Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA. ramanathanr@niaid.nih.gov
authors.forename: Roshan
authors.initials: R
authors.lastname: Ramanathan
authors.forename: Kawsar R
authors.initials: KR
authors.lastname: Talaat
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Fedorko
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Mahanty
authors.forename: Theodore E
authors.initials: TE
authors.lastname: Nash
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D007891:Leishmania / Q000145:classification* / Q000187:drug effects; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010767:Phosphorylcholine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013045:Species Specificity
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D000666:Amphotericin B; D007654:Ketoconazole