Efficacy of Miltefosine for Bolivian Cutaneous Leishmaniasis

Jaime Soto Fundación FADER, Bogota, Colombia; Puesto de Salud, Campamento OSCAR, Palos Blancos, Bolivia; Hospital de Clínicas, La Paz, Bolivia; and AB Foundation, Rockville, Maryland

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Jaime Rea Fundación FADER, Bogota, Colombia; Puesto de Salud, Campamento OSCAR, Palos Blancos, Bolivia; Hospital de Clínicas, La Paz, Bolivia; and AB Foundation, Rockville, Maryland

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Margarita Balderrama Fundación FADER, Bogota, Colombia; Puesto de Salud, Campamento OSCAR, Palos Blancos, Bolivia; Hospital de Clínicas, La Paz, Bolivia; and AB Foundation, Rockville, Maryland

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Julia Toledo Fundación FADER, Bogota, Colombia; Puesto de Salud, Campamento OSCAR, Palos Blancos, Bolivia; Hospital de Clínicas, La Paz, Bolivia; and AB Foundation, Rockville, Maryland

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Paula Soto Fundación FADER, Bogota, Colombia; Puesto de Salud, Campamento OSCAR, Palos Blancos, Bolivia; Hospital de Clínicas, La Paz, Bolivia; and AB Foundation, Rockville, Maryland

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Luis Valda Fundación FADER, Bogota, Colombia; Puesto de Salud, Campamento OSCAR, Palos Blancos, Bolivia; Hospital de Clínicas, La Paz, Bolivia; and AB Foundation, Rockville, Maryland

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Jonathan D. Berman Fundación FADER, Bogota, Colombia; Puesto de Salud, Campamento OSCAR, Palos Blancos, Bolivia; Hospital de Clínicas, La Paz, Bolivia; and AB Foundation, Rockville, Maryland

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Oral miltefosine (2.5 mg/kg/d for 28 days) was compared with intramuscular antimony (20 mg/kg/d for 20 days) in the treatment of cutaneous leishmaniasis caused by Leishmania braziliensis in Palos Blancos, Bolivia. The cure rates with 6 months of follow-up were statistically similar: 36 of 41 evaluable miltefosine patients (88%) versus 15 of 16 (94%) evaluable antimony patients. However, antimony cured more rapidly, because, by 1 month after therapy, 31 of 44 miltefosine patients (70%) compared with 16 of 16 antimony patients (100%) had achieved cure. The two conclusions from this work are that oral miltefosine can be used for cutaneous disease in this part of Bolivia and that miltefosine was more effective for L. braziliensis in this region than for L. braziliensis in Guatemala. Chemotherapy needs to be evaluated in each endemic region, even if the “same” species of Leishmania causes disease in these locales.

Author Notes

  • 1

    Murray HW, Berman JD, Davies CR, Saravia NG, 2005. Advances in leishmaniasis. Lancet 366 :1561–1577.

  • 2

    Sundar S, Jha TK, Thakur CP, Engel J, Sindermann H, Fischer C, Junge K, Bryceson A, Berman J, 2002. Oral miltefosine for Indian visceral leishmaniasis. N Engl J Med 347 :1739–1746.

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  • 3

    Soto J, Arana BA, Toledo J, Rizzo N, Vega JC, Diaz A, Luz M, Gutierrez P, Arboleda M, Berman JD, Junge K, Engel J, Sindermann H, 2004. Miltefosine for new world cutaneous leishmaniasis. Clin Infect Dis 38 :1266–1272.

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  • 4

    Davies CR, Reithinger R, Campbell-Lendrum D, Feliciangeli D, Borges R, Rodriguez N, 2000. The epidemiology and control of leishmaniasis in Andean countries. Cad Saude Publica 16 :925–950.

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  • 5

    Soto J, Toledo J, Valda L, Balderrama M, Rea I, Parra R, Ardiles J, Soto P, Gomez A, Molleda F, Fuentelsaz C, Anders G, Sindermann H, Engel J, Berman J, 2007. Treatment of Bolivian mucosal leishmaniasis with miltefosine. Clin Infect Dis 44 :350–356.

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  • 6

    Zentaris GmbH, 2004. Impavido Package Insert: Section 4.3. Frankfurt, Germany: Zentaris GmbH.

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