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Intralesional Pentamidine: A Novel Therapy for Single Lesions of Bolivian Cutaneous Leishmaniasis

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  • Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz, Bolivia; Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia; Hospital Local, Palos Blancos, Bolivia; Centro de Investigaciones Bioclínicas de la Fundación Fader (FADER-CIBIC), Bogota, Colombia; AB Foundation, North Bethesda, Maryland

A novel therapy, intralesional (IL) pentamidine, was compared to intralesional therapy with antimony (ILSb), a World Health Organization–recommended therapy, for single Bolivian Leishmania braziliensis lesions. In Study 1, 90 patients were randomized equally between three injections of ILSb over 5 days, five injections of ILSb over 11 days, and three injections of IL pentamidine (120 μg/mm2 lesion area [ILPenta-120-3]) over 5 days. Cure rates at 6 months were 57% for ILSb-3 injections, 73% for ILSb-5 injections, and 72% for ILPenta-120-3 injections. Adverse effects were local irritation and injection-site pain—ILSb (60 patients): mild (25), moderate (4); IL pentamidine (30 patients): mild (4), moderate (3). In Study 2, 60 patients were randomized equally between five injections of ILSb and three injections of a double dose of IL pentamidine (240 μg/mm2 [ILPenta-240-3]). In Study 2, cure rates were 67% for ILSb-5 injections and 73% for ILPenta-240-3. For three IL injections of pentamidine, efficacy was optimized at a dose of 120 μg/mm2 lesion area. The cure rate of that regimen was similar to that for ILSb-5 injections and nonstatistically larger than that of ILSb-3 injections. IL pentamidine is an attractive alternative to ILSb on the basis of efficacy for Bolivian L. braziliensis, the threat of Sb-resistant parasites, tolerance, and patient convenience of three visits over 5 days.

Author Notes

* Address correspondence to Jaime Soto, FUNDERMA, Av. Calle Las Palmas No. 199, Santa Cruz, Bolivia. E-mail: jaime.soto@infoleis.com

Financial support: Funded by a grant from the AB Foundation to Jaime Soto.

Authors' addresses: Jaime Soto, FUNDERMA, Santa Cruz, Bolivia, E-mail: jaime.soto@infoleis.com. David Paz, Daniela Rivero, and Paula Soto, Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia, E-mails: davidpazmendoza@hotmail.com, p_d_rivero@hotmail.com, and miltefosinabolivia2015@gmail.com. Jorge Quispe, Hospital Local, Palos Blancos, Bolivia. Julia Toledo, Centro de Investigaciones Bioclínicas de la Fundación Fader, FADER-CIBIC, Bogota, Colombia, E-mail: Toledo_julia@hotmail.com. Jonathan Berman, AB foundation, North Bethesda, MD, E-mail: jbe9320457@aol.com.

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