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Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis.
Br J Dermatol. 2011 Aug; 165(2):411-4.BJ

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.

OBJECTIVES

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.

CONCLUSION

Oral miltefosine, 50mg thrice daily for 60 days or twice daily for 90 days, could be an effective treatment for PKDL.

Authors+Show Affiliations

Department of Dermatology, Safdarjung Hospital Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi 110029, India. weramesh@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21561437

Citation

Ramesh, V, et al. "Miltefosine as an Effective Choice in the Treatment of Post-kala-azar Dermal Leishmaniasis." The British Journal of Dermatology, vol. 165, no. 2, 2011, pp. 411-4.
Ramesh V, Katara GK, Verma S, et al. Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis. Br J Dermatol. 2011;165(2):411-4.
Ramesh, V., Katara, G. K., Verma, S., & Salotra, P. (2011). Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis. The British Journal of Dermatology, 165(2), 411-4. https://doi.org/10.1111/j.1365-2133.2011.10402.x
Ramesh V, et al. Miltefosine as an Effective Choice in the Treatment of Post-kala-azar Dermal Leishmaniasis. Br J Dermatol. 2011;165(2):411-4. PubMed PMID: 21561437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis. AU - Ramesh,V, AU - Katara,G K, AU - Verma,S, AU - Salotra,P, PY - 2011/5/13/entrez PY - 2011/5/13/pubmed PY - 2011/10/18/medline SP - 411 EP - 4 JF - The British journal of dermatology JO - Br J Dermatol VL - 165 IS - 2 N2 - 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. OBJECTIVES: 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. CONCLUSION: Oral miltefosine, 50mg thrice daily for 60 days or twice daily for 90 days, could be an effective treatment for PKDL. SN - 1365-2133 UR - https://www.unboundmedicine.com/medline/citation/21561437/Miltefosine_as_an_effective_choice_in_the_treatment_of_post_kala_azar_dermal_leishmaniasis_ L2 - https://doi.org/10.1111/j.1365-2133.2011.10402.x DB - PRIME DP - Unbound Medicine ER -