Abstract
Background. Post-kala-azar dermal leishmaniasis (PKDL) plays an important role in maintaining endemicity of visceral leishmaniasis and its transmission. Treatment regimens for PKDL are toxic and require 3-4 months of hospitalization. These long and arduous regimens result in extensive noncompliance. There is an urgent need to develop a safe, effective, and acceptable regimen for the treatment of PKDL. Paromomycin (PM) has been recently approved in India for treatment of visceral leishmaniasis (VL); hence we tested its efficacy in patients with PKDL. Methods. In this exploratory study, 31 patients with PKDL aged 10 years and above were administered PM 11 mg/kg daily intramuscularly for 45 days and followed up for one year. Results. Out of 31 patients, 7 patients were lost to followup at 1 year and 9 (37.5%) got cured with complete disappearance of lesion, while 15 (62.5%) showed no improvement by per protocol analysis. Conclusion. Cure rate with 45 intramuscular injections of PM was unacceptably low though there was no serious side effect of the drug. Whether paromomycin can be used in multidrug therapy to shorten the duration of treatment should be the next logical step for investigation.
Highlights
Post-kala-azar dermal leishmaniasis (PKDL) is a dermal manifestation of Leishmania donovani infection and often follows resolution of clinical visceral leishmaniasis (VL)
Thirty-one patients with PKDL were included in the study out of which three patients did not give a history of a prior episode of VL
Amongst the previously treated patients for VL, 22 patients were treated with sodium stibogluconate (SSG), 3 patients with amphotericin B and miltefosine each, and 1 patient with paromomycin
Summary
Post-kala-azar dermal leishmaniasis (PKDL) plays an important role in maintaining endemicity of visceral leishmaniasis and its transmission. Treatment regimens for PKDL are toxic and require 3-4 months of hospitalization. These long and arduous regimens result in extensive noncompliance. There is an urgent need to develop a safe, effective, and acceptable regimen for the treatment of PKDL. Paromomycin (PM) has been recently approved in India for treatment of visceral leishmaniasis (VL); we tested its efficacy in patients with PKDL. In this exploratory study, 31 patients with PKDL aged years and above were administered PM mg/kg daily intramuscularly for 45 days and followed up for one year. Cure rate with 45 intramuscular injections of PM was unacceptably low though there was no serious side effect of the drug. Whether paromomycin can be used in multidrug therapy to shorten the duration of treatment should be the logical step for investigation
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