Efficacy of Extended (Six Weeks) Treatment with Miltefosine for Mucosal Leishmaniasis in Bolivia

Jaime Soto Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia; Proyecto Obras Sociales de Caminos de Acceso Rur, Palos Blancos, Bolivia; Departamento Médico, Hospital de Clínicas, La Paz, Bolivia; Servicio de Otorrinolaringología, Hospital de Clínicas, La Paz; Fast-Track Drugs and Biologics LLC, North Potomac, Maryland

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Jaime Rea Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia; Proyecto Obras Sociales de Caminos de Acceso Rur, Palos Blancos, Bolivia; Departamento Médico, Hospital de Clínicas, La Paz, Bolivia; Servicio de Otorrinolaringología, Hospital de Clínicas, La Paz; Fast-Track Drugs and Biologics LLC, North Potomac, Maryland

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Margarita Valderrama Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia; Proyecto Obras Sociales de Caminos de Acceso Rur, Palos Blancos, Bolivia; Departamento Médico, Hospital de Clínicas, La Paz, Bolivia; Servicio de Otorrinolaringología, Hospital de Clínicas, La Paz; Fast-Track Drugs and Biologics LLC, North Potomac, Maryland

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Julia Toledo Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia; Proyecto Obras Sociales de Caminos de Acceso Rur, Palos Blancos, Bolivia; Departamento Médico, Hospital de Clínicas, La Paz, Bolivia; Servicio de Otorrinolaringología, Hospital de Clínicas, La Paz; Fast-Track Drugs and Biologics LLC, North Potomac, Maryland

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Luis Valda Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia; Proyecto Obras Sociales de Caminos de Acceso Rur, Palos Blancos, Bolivia; Departamento Médico, Hospital de Clínicas, La Paz, Bolivia; Servicio de Otorrinolaringología, Hospital de Clínicas, La Paz; Fast-Track Drugs and Biologics LLC, North Potomac, Maryland

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Jaime Ardiles Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia; Proyecto Obras Sociales de Caminos de Acceso Rur, Palos Blancos, Bolivia; Departamento Médico, Hospital de Clínicas, La Paz, Bolivia; Servicio de Otorrinolaringología, Hospital de Clínicas, La Paz; Fast-Track Drugs and Biologics LLC, North Potomac, Maryland

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Jonathan Berman Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia; Proyecto Obras Sociales de Caminos de Acceso Rur, Palos Blancos, Bolivia; Departamento Médico, Hospital de Clínicas, La Paz, Bolivia; Servicio de Otorrinolaringología, Hospital de Clínicas, La Paz; Fast-Track Drugs and Biologics LLC, North Potomac, Maryland

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We investigated whether increasing the period of follow-up or increasing the duration of therapy would markedly alter the 71% cure rate of mucosal leishmaniasis in Bolivia consequent to treatment with miltefosine for 4 weeks. Increasing the follow-up from 12 months to 24 months demonstrated additional relapse in only 2 of 41 patients. Increasing the period of therapy from 4 weeks to 6 weeks only increased the cure rate to 75%. The cure rate of mucosal leishmaniasis in Bolivia, whether 4 or 6 weeks of therapy is used and whether 12 month or 24 months follow up is conducted, is approximately 70%.

  • 1

    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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  • 2

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  • 3

    Llanos-Cuentas A, Echevaria J, Cruz M, La Rosa A, Campos M, Franke E, Berman J, Modabber F, Marr J, 1997. Efficacy of sodium stibogluconate alone and in combination with allopurinol for treatment of mucocutaneous leishmaniasis. Clin Infect Dis 25 :677–684.

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  • 4

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  • 5

    Dorlo TP, van Thiel PP, Huitema AD, Keizer RJ, de Vries HJ, Beijnen JH, de Vries PJ, 2008. Pharmacokinetics of miltefosine in Old World cutaneous leishmaniasis patients. Antimicrob Agents Chemother 52 :2855–2860.

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  • 6

    Oliveira-Neto MP, Mattos M, Pirmez C, de Sousa CFS, Junior GG, 2000. Mucosal leishmaniasis (espundia) responsive to low dose of n-methyl glucamine (glucantime) in Rio de Janeiro, Brazil. Rev Inst Med Trop São Paulo 42: 321–325.

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  • 7

    Machado PR, Lessa H, Lessa M, Guimarães LH, Bang H, Ho JL, Carvalho EM, 2007. Oral pentoxifylline combined with pentavalent antimony: a randomized trial for mucosal leishmaniasis. Clin Infect Dis 44 :788–793.

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