Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Am Acad Dermatol. 2013 Feb;68(2):284-9. doi: 10.1016/j.jaad.2012.06.014. Epub 2012 Aug 1.
New World cutaneous leishmaniasis is mostly acquired in the Amazon Basin of Bolivia where L viannia (V) braziliensis is endemic. Treatment with systemic pentavalent antimonial compounds has been shown to be effective in achieving clinical cure in only 75% of cases.
We sought to assess the efficacy and safety of liposomal amphotericin B (L-AmB) treatment for primary infection of cutaneous L (V) braziliensis.
A prospective observational evaluation was performed for cutaneous leishmaniasis due to L (V) braziliensis which was treated with L-AmB, 3 mg/kg, for 5 consecutive days, and a sixth dose on day 10. This therapy regimen was compared with the treatment regimen of sodium stibogluconate (SSG) 20 mg/kg for 3 weeks.
Our study was divided into two groups; 34 patients received L-AmB and 34 received SSG treatment. Almost all patients were infected in Bolivia. In the L-AmB group, 29 patients (85%) had complete cure compared with 70% in the SSG group (P = not significant), 4 other patients were slow healers, and only one patient needed additional treatment with SSG. No relapses were seen during a mean 29-month follow-up period. Failure rate was 3% in the L-AmB versus 29% in the SSG group (P = .006). Treatment was interrupted in 65% of patients taking SSG because of adverse events, whereas all patients receiving L-AmB completed treatment.
This was a non-blinded comparative study.
Comparison of L-Amb to SSG treatment for L (V) braziliensis shows that the former is effective, better tolerated, and more cost effective. L-AmB should therefore be considered as the first-line treatment option for cutaneous L (V) braziliensis infection.
新热带皮肤利什曼病主要发生在玻利维亚亚马逊流域，那里流行的是利什曼原虫（V）巴西利什曼原虫。全身性五价锑化合物治疗已被证明在 75%的病例中能有效实现临床治愈。
我们旨在评估脂质体两性霉素 B（L-AmB）治疗原发性皮肤利什曼原虫（V）巴西利什曼原虫感染的疗效和安全性。
对因利什曼原虫（V）巴西利什曼原虫引起的皮肤利什曼病进行了前瞻性观察评估，采用 L-AmB 治疗，剂量为 3mg/kg，连续 5 天，第 10 天给予第 6 剂。该治疗方案与葡萄糖酸锑钠（SSG）20mg/kg治疗 3 周的方案进行了比较。
我们的研究分为两组；34 例患者接受 L-AmB 治疗，34 例患者接受 SSG 治疗。几乎所有患者均在玻利维亚感染。在 L-AmB 组，29 例（85%）患者完全治愈，而 SSG 组为 70%（P=无显著差异），4 例患者为愈合缓慢者，仅 1 例患者需要用 SSG 进行额外治疗。在平均 29 个月的随访期间，未观察到复发。L-AmB 组的失败率为 3%，而 SSG 组为 29%（P=0.006）。由于不良反应，65%接受 SSG 治疗的患者中断了治疗，而所有接受 L-AmB 治疗的患者均完成了治疗。
这是一项非盲比较研究。
将 L-Amb 与 SSG 治疗利什曼原虫（V）巴西利什曼原虫进行比较表明，前者有效、耐受性更好、更具成本效益。因此，L-AmB 应被视为治疗皮肤利什曼原虫（V）巴西利什曼原虫感染的首选方案。
