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Liposomal amphotericin B in comparison to sodium stibogluconate for cutaneous infection due to Leishmania braziliensis.
J Am Acad Dermatol. 2007 Apr; 56(4):612-6.JA

Abstract

BACKGROUND

New World cutaneous leishmaniasis among Israeli travelers is mostly acquired in the Amazon Basin of Bolivia where Leishmania viannia (V.) braziliensis is endemic. Treatment with systemic pentavalent antimonial compounds is effective in achieving clinical cure in only 75% of cases. In this study, we assessed liposomal amphotericin B (AmBisome) as an alternative treatment for cutaneous L (V.) braziliensis infection.

METHODS

A prospective evaluation was performed for cutaneous leishmaniasis due to L (V.) braziliensis, proven by polymerase chain reaction. A 3-mg/kg AmBisome dose was given for 5 consecutive days, and a sixth dose on day 10, all in an outpatient setting. This therapy was compared with a series of historical patients who were treated with sodium stibogluconate (SSG).

RESULTS

Seven consecutive patients, 5 males and 2 females, received AmBisome treatment. All were returned travelers infected in Bolivia; their mean age was 23.1 years; 5 had failed to respond to a full course of SSG; two had a primary lesion; none had mucosal lesions. All achieved complete clinical cure within less than 1 month. Mean follow-up of 12 months revealed no relapses. Side effects were mild, and none had to terminate treatment prematurely. Comparison of AmBisome to SSG treatment shows that the former is safer, with fewer recurrence rates. Additionally, the expense of the total care with AmBisome is less than with SSG: 45% less if SSG was given in an inpatient setting; 15% less when SSG was given in an outpatient setting.

LIMITATIONS

This was a nonrandomized study, with relatively few patients.

CONCLUSION

AmBisome treatment for L (V.) braziliensis appears to be effective, better tolerated, and to have more cost benefit in countries where hospital-care costs are significant.

Authors+Show Affiliations

Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17276541

Citation

Solomon, Michal, et al. "Liposomal Amphotericin B in Comparison to Sodium Stibogluconate for Cutaneous Infection Due to Leishmania Braziliensis." Journal of the American Academy of Dermatology, vol. 56, no. 4, 2007, pp. 612-6.
Solomon M, Baum S, Barzilai A, et al. Liposomal amphotericin B in comparison to sodium stibogluconate for cutaneous infection due to Leishmania braziliensis. J Am Acad Dermatol. 2007;56(4):612-6.
Solomon, M., Baum, S., Barzilai, A., Scope, A., Trau, H., & Schwartz, E. (2007). Liposomal amphotericin B in comparison to sodium stibogluconate for cutaneous infection due to Leishmania braziliensis. Journal of the American Academy of Dermatology, 56(4), 612-6.
Solomon M, et al. Liposomal Amphotericin B in Comparison to Sodium Stibogluconate for Cutaneous Infection Due to Leishmania Braziliensis. J Am Acad Dermatol. 2007;56(4):612-6. PubMed PMID: 17276541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liposomal amphotericin B in comparison to sodium stibogluconate for cutaneous infection due to Leishmania braziliensis. AU - Solomon,Michal, AU - Baum,Sharon, AU - Barzilai,Aviv, AU - Scope,Alon, AU - Trau,Henry, AU - Schwartz,Eli, Y1 - 2007/02/05/ PY - 2006/03/23/received PY - 2006/06/06/revised PY - 2006/06/14/accepted PY - 2007/2/6/pubmed PY - 2007/3/30/medline PY - 2007/2/6/entrez SP - 612 EP - 6 JF - Journal of the American Academy of Dermatology JO - J Am Acad Dermatol VL - 56 IS - 4 N2 - BACKGROUND: New World cutaneous leishmaniasis among Israeli travelers is mostly acquired in the Amazon Basin of Bolivia where Leishmania viannia (V.) braziliensis is endemic. Treatment with systemic pentavalent antimonial compounds is effective in achieving clinical cure in only 75% of cases. In this study, we assessed liposomal amphotericin B (AmBisome) as an alternative treatment for cutaneous L (V.) braziliensis infection. METHODS: A prospective evaluation was performed for cutaneous leishmaniasis due to L (V.) braziliensis, proven by polymerase chain reaction. A 3-mg/kg AmBisome dose was given for 5 consecutive days, and a sixth dose on day 10, all in an outpatient setting. This therapy was compared with a series of historical patients who were treated with sodium stibogluconate (SSG). RESULTS: Seven consecutive patients, 5 males and 2 females, received AmBisome treatment. All were returned travelers infected in Bolivia; their mean age was 23.1 years; 5 had failed to respond to a full course of SSG; two had a primary lesion; none had mucosal lesions. All achieved complete clinical cure within less than 1 month. Mean follow-up of 12 months revealed no relapses. Side effects were mild, and none had to terminate treatment prematurely. Comparison of AmBisome to SSG treatment shows that the former is safer, with fewer recurrence rates. Additionally, the expense of the total care with AmBisome is less than with SSG: 45% less if SSG was given in an inpatient setting; 15% less when SSG was given in an outpatient setting. LIMITATIONS: This was a nonrandomized study, with relatively few patients. CONCLUSION: AmBisome treatment for L (V.) braziliensis appears to be effective, better tolerated, and to have more cost benefit in countries where hospital-care costs are significant. SN - 1097-6787 UR - https://www.unboundmedicine.com/medline/citation/17276541/Liposomal_amphotericin_B_in_comparison_to_sodium_stibogluconate_for_cutaneous_infection_due_to_Leishmania_braziliensis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(06)01790-7 DB - PRIME DP - Unbound Medicine ER -