Berman J D
Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA.
Clin Dermatol. 1996 Sep-Oct;14(5):519-22. doi: 10.1016/0738-081x(96)00048-x.
The most extensive investigations of treatment of New World cutaneous leishmaniasis have been performed against L. panamensis disease in Colombia, and the relative value of regimens shown there may be instructive for disease from other areas. In Colombia, a 90-95% cure rate was achieved with three different drug regimens: The standard regimen of pentavalent antimony (20 mg/ kg/day for 20 days parenterally) A short course of pentamidine (3 mg/kg every other day for four injections intramuscularly The marketed combination of topical paromomycin (15%)-MBCl (12%) for 10 days, plus antimony (20 mg/kg/day parenterally) for 7 days. My view is that all these regimens could be chosen as first-line therapy for cutaneous disease in Colombia. The antimony regimen has the advantage of established use; the disadvantages are cost, requirement for injections each day for 20 days, and considerable morbidity in the last two weeks of therapy. The pentamidine regimen has the advantage of a short time course; the disadvantages are lack of experience with this new regimen and frequent, although moderate, morbidity. The combined topical-parenteral regimen has the advantage of requiring few and nontoxic injections; the primary disadvantage is that the regimen is novel and its efficacy has not been confirmed. It would be expected that cases of lesions in other areas caused by L. braziliensis complex would respond in a similar manner to these regimens. To date, however, only the efficacy of the standard antimonial regimen has been confirmed. In certain regions of Central America, other regimens may be effective. Thus, ketoconazole appears to be effective for the more rapidly self-curing forms of disease (cutaneous disease caused by L. mexicana and L. panamensis from Central America), and a short course of antimony may be effective against L. braziliensis in Guatemala.
针对哥伦比亚巴拿马利什曼原虫病开展了关于新大陆皮肤利什曼病治疗的最广泛研究，那里所显示的治疗方案的相对价值可能对其他地区的该病治疗具有指导意义。在哥伦比亚，三种不同的药物治疗方案均实现了90% - 95%的治愈率：五价锑标准方案（20毫克/千克/天，静脉注射20天）；喷他脒短程疗法（3毫克/千克，隔日一次，肌肉注射四次）；市售的局部用巴龙霉素（15%）-灭瘢灵（12%）联合用药10天，加锑剂（20毫克/千克/天，静脉注射）7天。我的观点是，所有这些方案都可被选作哥伦比亚皮肤利什曼病的一线治疗方案。锑剂方案的优势在于其已确立的应用；缺点是成本高、需连续20天每日注射，且在治疗的最后两周有相当高的发病率。喷他脒方案的优势在于疗程短；缺点是该新方案缺乏经验，且发病率虽为中度但较为频繁。局部 - 静脉联合方案的优势在于所需注射次数少且无毒；主要缺点是该方案新颖，其疗效尚未得到证实。预计巴西利什曼原虫复合种在其他地区引起的病变病例对这些方案的反应会相似。然而，迄今为止，仅标准锑剂方案的疗效得到了证实。在中美洲的某些地区，其他方案可能有效。因此，酮康唑似乎对病情自愈较快的类型（中美洲墨西哥利什曼原虫和巴拿马利什曼原虫引起的皮肤利什曼病）有效，而短程锑剂治疗可能对危地马拉的巴西利什曼原虫有效。
