Treatment of Cutaneous Leishmaniasis With a Combination of Miltefosine and Antimony
Treatment of Cutaneous Leishmaniasis With a Combination of Miltefosine and Antimony
Cutaneous leishmaniasis is endemic in the New World and, until recently, the standard
 treatment was pentavalent antimony. The cure rate for L panamensis in Colombia is 91%-93% and
 the cure rate in Bolivia is also 90%. Nevertheless, pentavalent antimonials have the
 disadvantages of multiple injections and mild-moderate clinical toxicity all of which are
 particularly unpleasant for a moderate clinical problem such as cutaneous leishmaniasis.

 The oral agent Miltefosine has now been shown to be as effective as antimony in Colombia and
 Bolivia (91 and 92% respectively). Side effects seen in patients with cutaneous disease that
 can be specifically attributed to the drug are nausea and vomiting of mild grade in
 approximately 25% of patients, and low-grade elevation of creatinine also in approximately
 25% of patients. A further disadvantage of miltefosine is that regimens shorter than 4 weeks
 have not been evaluated for cutaneous disease.

 Combination therapy is now being used for many infectious diseases, such as tuberculosis,
 malaria, and HIV. Combination therapy offers the potential of preventing drug resistance,
 because organisms resistant to one of the drugs may be susceptible to the other drug; and
 also the potential to diminish drug therapy duration and thus side effects. These two
 potential benefits to some extent contradict each other: preventing resistance is best done
 if full courses of both drugs is used; diminishing therapy duration means using less than the
 full course of each drug. The optimum combination regimen is one in which sufficient amounts
 of both drugs are used to have high efficacy, yet the amounts are as low as possible to spare
 patients unnecessarily long courses of drug.

 In the present protocol, the combination of a half-course of miltefosine and a half-course of
 antimony will be evaluated for efficacy and tolerance. The combination of miltefosine and
 antimony is chosen because these are now the two standard agents in Bolivia, and in vitro the
 combination was additive to mildly synergistic against a standard leishmania strain.
Inclusion Criteria:

 -  Parasitological confirmation

 -  at least 1 lesion must be ulcerative

 -  No specific antileishmanial therapy during the previous six months

 Exclusion Criteria:

 -  Concomitant diseases such as Tuberculosis, HIV, diabetes, renal failure, liver disease

 -  abnormalities CTC 2 in blood, liver, kidney test or EKG