title: Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis.
abstract: BACKGROUND
  Post-kala-azar dermal leishmaniasis (PKDL) constitutes a parasite reservoir important in the transmission of visceral leishmaniasis (VL). Unacceptable treatment regimens and increasing drug resistance blight control programmes. The success of oral miltefosine in VL prompted a clinical, histopathological and parasitological study of this drug in PKDL.
  
  
  OBJECTIVE
  To define the dose and duration of miltefosine for treatment of PKDL.
  
  
  METHODS
  Twenty-six patients confirmed by slit-skin smear, histopathology and molecular tests were enrolled in the study. They received miltefosine capsules 50 mg thrice daily after food. Treatment was for 60 days with a provision to increase by 30 days if a responder had not attained a cure. Cure was ascertained by clinical and histopathological examination, and measuring parasite burden using real-time polymerase chain reaction.
  
  
  RESULTS
  Twenty-four patients with a wide range of parasite burden completed the study. Twenty-three achieved a cure giving an initial cure rate of 96% (95% confidence interval 79-99%). Sixteen patients were cured with 50 mg thrice daily, 13 in 60 days and three within 90 days. In seven cases, miltefosine had to be reduced, because of gastrointestinal intolerance, to 50 mg twice daily to a total of 180 capsules. Lesional parasites were undetectable at 1 month post-treatment. Treatment was safe with no relapses at 1-year follow-up.
  
  
  CONCLUSIONS
  Oral miltefosine, 50mg thrice daily for 60 days or twice daily for 90 days, could be an effective treatment for PKDL.
authors.affiliation: Department of Dermatology, Safdarjung Hospital Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi 110029, India. weramesh@hotmail.com
authors.forename: V
authors.initials: V
authors.lastname: Ramesh
authors.forename: G K
authors.initials: GK
authors.lastname: Katara
authors.forename: S
authors.initials: S
authors.lastname: Verma
authors.forename: P
authors.initials: P
authors.lastname: Salotra
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000150:complications / Q000188:drug therapy*; D007898:Leishmaniasis, Visceral / Q000150:complications*; D008297:Male; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D010767:Phosphorylcholine; C039128:miltefosine