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Evidence summaries

Interventions for Old World Cutaneous Leishmaniasis

In Leishmania major infections oral fluconazole, paromomycin methylbenzethonium chloride and photodynamic therapy may be of benefit. In Leishmania tropica infections, itraconazole may be superior to placebo. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 49 studies with a total of 5 559 subjects. Only two studies contained sufficiently similar data to pool.

In Leishmania major infections, there was reasonable RCT evidence of benefit of cure when compared to placebo for 200 mg oral fluconazole wor 6 weeks (RR 2.78, 95% CI 1.86 to 4.16, 1 RCT n = 200), topical 15% paromomycin + 12% methylbenzethonium chloride twice daily for 28 days (PR-MBCL) (RR 3.09, 95% CI 1.14 to 8.37, 1 RCT n = 60) and photodynamic therapy (RR 7.02, 95% CI 3.80 to 17.55, 1 RCT n = 60). Topical PR-MBCL was less efficacious than photodynamic therapy weekly for four weeks (RR 0.44, 95% CI 0.29 to 0.66, 1 RCT n = 65). Oral pentoxifylline was a good adjuvant therapy to intramuscular meglumine antimoniate (IMMA) when compared to IMMA plus placebo (RR 1.63, 95% CI 1.11 to 2.39, 1 RCT n = 64)

In Leishmania tropica infections, there was good evidence of benefit for the use of 200 mg oral itraconazole for 6 weeks compared with placebo (RR 7.00, 95% CI 1.04 to 46.95, 1 RCT n = 20), for intralesional sodium stibogluconate (RR 2.62, 95% CI 1.78 to 3.86, 1 RCT n = 292), and for thermotherapy compared with intramuscular sodium stibogluconate (RR 2.99, 95% CI 2.04 to 4.37, 1 RCT n = 283).

The evidence was insufficient to support many other treatments commonly used in this condition.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and lack of blinding) and by imprecise results (limited study size for each comparison).

    References

    • González U, Pinart M, Reveiz L, Alvar J. Interventions for Old World cutaneous leishmaniasis. Cochrane Database Syst Rev 2008 Oct 8;(4):CD005067. [PubMed]

Primary/Secondary Keywords