Topical Paromomycin Research Articles

A Comparative Study of Aminosidine Sulfate, Meglomine Antimoniate, Combination of both and Glucantime in Murine Leishmaniasis Treatment of Cutaneous Leishmaniasis, Caused by Leishmania tropica, with Topical Application of Paromomycin 20% in BALB-c Mice

The current treatment of choice for cutaneous leishmaniasis is either parenteral or intralesional antimonial compounds. Each of these treatments has its own downfalls which include toxic side effects with the parentral injection and pain at the site of injection with the intralesional injection. In recent years, there has been more focus on Paromomycin as an alternative drug; however, current data arose many controversies. In this study, the efficacy of different therapeutic regimens including topical paromomycin 20%, topical gentamycin 0.5%, intralesional glucantime injections, topical paromomycin 20% combine with gentamycin 0.5%, and placebo were compared. The results showed that the topical application of paromomycin had better response, less recurrence. In conclusion, topical paromomycin 20% can be an appropriate substitute for intralesional injection of glucantime, but more studies are needed to support its efficacy in human cutaneous leishmaniasis.

Comparison between the efficacy of photodynamic therapy and topical paromomycin in the treatment of Old World cutaneous leishmaniasis: a placebo-controlled, randomized clinical trial

The optimal treatment for cutaneous leishmaniasis (CL) is not known. Topical paromomycin is one of the many drugs that have been suggested for the treatment of CL caused by Leishmania major. Recently, topical photodynamic therapy (PDT) has been reported to be effective in the treatment of CL. To compare the parasitological and clinical efficacy of PDT vs. topical paromomycin in patients with Old World CL caused by L. major in Iran. In this trial, 60 patients with the clinical and parasitological diagnosis of CL were recruited and were randomly divided into three treatment groups of 20 subjects each. Group 1 was treated with weekly topical PDT, and groups 2 and 3 received twice-daily topical paromomycin and placebo, respectively. The duration of treatment was 4 weeks for all groups. These groups were followed for 2 months after the end of treatment. In total, 57 patients with 95 lesions completed the study. At the end of the study, complete improvement was seen in 29 of 31 (93.5%), 14 of 34 (41.2%) and 4 of 30 lesions (13.3%) in groups 1, 2 and 3, respectively (P<0.001). At the same time point, 100%, 64.7% and 20% of the lesions had parasitological cure in group 1, 2 and 3, respectively (P<0.001). Topical PDT can be used safely as a rapid and highly effective alternative treatment choice for Old World CL in selected patients.

Comparison between the efficacy of photodynamic therapy and topical paromomycin in the treatment of old world cutaneous leishmaniasis: A placebo-controlled, randomized clinical trial

Background: The optimal treatment for cutaneous leishmaniasis (CL) is not known. Topical paromomycin is one of the many drugs that have been suggested for the treatment of CL caused by Leishmania major. Recently, topical photodynamic therapy (PDT) has been reported to be effective in the treatment of CL. This study aimed to compare the parasitological and clinical efficacy of PDT versus topical paromomycin in patients with old world CL caused by L. major in Iran. Materials and Methods: In this trial, sixty patients with the clinical and parasitological diagnosis of CL were recruited and were randomly divided into three treatment groups with twenty subjects in each group. Group 1 was treated with weekly topical PDT and groups 2 and 3 received twice daily topical paromomycin and placebo, respectively. The duration of treatment was four weeks for all groups. These groups were followed up for 2 months after the end of treatment. Results: 57 patients with 95 lesions completed the study. At the end of the study, complete improvement was seen in 29 of 31 (93.5%), 14 of 34 (41.2%) and 4 of 30 (13.3%) of the lesions in group 1, 2 and 3 respectively ( P <0.001). At the same time point, 100%, 64.7 and 20% of the lesions had parasitological cure in group 1, 2 and 3, respectively ( P <0.001). Conclusion: Topical PDT can be used safely as a rapid and highly effective alternative choice for treatment of old world CL in the selected patients.

Clinical status of agents being developed for leishmaniasis

Leishmaniasis, which exists in both visceral and cutaneous forms, is currently treated with intramuscular antimony or intravenous amphotericin B. The primary unmet need is for oral therapy. Of the several drugs in clinical development, miltefosine is unique in being an oral agent with efficacy against both forms of the disease. Sitamaquine is an oral agent with substantial but not sufficient efficacy against visceral disease. Oral fluconazole has been shown to be more effective than placebo in one instance: for Leishmania major cutaneous disease from Saudi Arabia. Paromomycin is in widespread trial. Topical paromomycin formulations are being tested for cutaneous disease, and intramuscular paromomycin is in Phase III trial for Indian visceral disease. The most likely replacements for present therapy are oral miltefosine for many of the visceral and cutaneous syndromes, intramuscular paromomycin for visceral disease and topical paromomycin for some forms of cutaneous disease.

Leishmania tropica in northern Israel: A clinical overview of an emerging focus

In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israel. The aim of this study was to evaluate clinical (size, number, location, and type of lesion) and laboratory (culture and polymerase chain reaction [PCR] analysis) parameters at diagnosis, response to treatment, and outcome of patients with CL due to L tropica. Between September 2002 and March 2004, patients with direct smear-confirmed CL were evaluated; clinical records were reviewed and a telephone survey was performed. Forty nine patients, 34 (69%) male and 15 (31%) female, were studied. Mean age was 31.1 years (median 26 years, range 1-70); 76% of patients live in Tiberias and the surrounding area. The mean number of lesions was 2.6 (median 2, range 1-10). Lesions were commonly located on the face (61%) and upper limbs (57%). PCR analysis was performed in 27 patients and was positive for L tropica in 26. Fifty percent of patients studied received multiple therapeutic regimens because of incomplete response or treatment failure. Topical paromomycin was used in 44 patients (90%), with a complete response reported in only 17 (39%); of the 9 patients treated with intralesional sodium stibogluconate, a complete response was reported in 6 (67%); of the 5 patients treated with intravenous sodium stibogluconate, 4 (80%) were cured. The relatively small number of patients studied combined with the fact that some were assessed retrospectively limit our conclusions. In addition, 50% of the patients studied received multiple therapeutic regimens because of failure of, or incomplete responses to, their initial therapy, thereby making comparisons difficult. The cure rate in those completing a course of antimony therapy, either 10 or more days of intravenous therapy or therapy administered intralesionally, was 75% (95% confidence interval [CI], 50.5-99.5%) as compared with 45% (95% CI, 28.9-60.5%) among those completing at least 10 days of topical paromomycin. To date, no standardized, simple, safe, and highly effective regimen for treating L tropica exists. Large, controlled clinical trials to evaluate current treatment regimens as well as new medications for CL, and especially CL attributed to L tropica, are urgently needed.

Comparing the efficiency of topical paromomycin with intralesional meglumine antimoniate for cutaneous leishmaniasis

International Journal of DermatologyVolume 44, Issue 12 p. 1064-1065 Comparing the efficiency of topical paromomycin with intralesional meglumine antimoniate for cutaneous leishmaniasis Zahra Moosavi MD, Zahra Moosavi MD Ahvaz, IranSearch for more papers by this author Abdolhamid Nakhli MD, Abdolhamid Nakhli MD Ahvaz, IranSearch for more papers by this author Sima Rassaii MD, Sima Rassaii MD Ahvaz, IranSearch for more papers by this author Zahra Moosavi MD, Zahra Moosavi MD Ahvaz, IranSearch for more papers by this author Abdolhamid Nakhli MD, Abdolhamid Nakhli MD Ahvaz, IranSearch for more papers by this author Sima Rassaii MD, Sima Rassaii MD Ahvaz, IranSearch for more papers by this author First published: 23 December 2004 https://doi.org/10.1111/j.1365-4632.2004.02597.xCitations: 8Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume44, Issue12December 2005Pages 1064-1065 RelatedInformation

Comparison of the effectiveness of two topical paromomycin treatments versus meglumine antimoniate for New World cutaneous leishmaniasis

The randomized, controlled study compared the therapeutic efficacy and safety of two paromomycin-containing topical preparations with the gold treatment standard, meglumine antimoniate, and with each other in 120 Ecuadorian patients with ulcerated lesions. The two paromomycin treatment comparisons were double-blinded. Group 1 ( n=40) received 15% paromomycin plus 12% methylbenzonium chloride (PR–MBCL) dissolved in a soft white paraffin base, applied twice daily for 30 days. Group 2 ( n=40) was also treated for 30 days with 15% paromomycin plus 10% urea (PR–U) dissolved in the same paraffin base. Group 3 ( n=40) received 20 mg/kg/day of IM meglumine antimoniate (MA) for 10 days as per Ecuadorian Ministry of Public Health recommendations at the time of the study. The 10-day treatment was completed by 90% of the MA group compared to 72.5% of the PR–MBCL ( X 2=4.0, P=0.045) and 75% of the PM–U ( X 2=3.1, P>0.05) groups whose treatment regime lasted 20 days longer than the MA treatment. Post-treatment lesion burning, redness, inflammation, and soreness were more common in the two paromomycin groups compared to MA group ( P<0.05). The frequency of treatment-related side effects in the two paromomycin groups was similar. Six weeks after the start of treatment, 80.6% of MA subjects were clinically cured compared to 48.3% in the PR–MBCL ( X 2=6.1, P=0.014) and 40% in the PM–U groups ( X 2=12.6, P=0.002). By 12 weeks, the proportion of clinically cured subjects in the MA (91.7%) compared to PM–MBCL (79.3%) or PM–U (70%) groups was not significantly different ( P>0.05). MA-treated subjects clinically cured by 12 weeks had a faster mean healing time (29.5±12.2 days) compared to those in the PM–MBCL (versus 43.1±14.4 days, t=−3.7, P=0.001) or PR–U groups (43.5±17 days; t=−3.2, P=0.002). During the 48-week post-treatment follow-up period, infection reactivation was observed in 15.2% of the MA subjects compared to 17.4% in the PM–MBCL and 10.5% PM–U of subjects diagnosed as clinically healed by 12 weeks ( P>0.05). The results suggest that although the time required for the clinical healing of ulcerated lesions takes longer, topical paromomycin may be an acceptable therapeutic alternative in endemic areas where meglumine antimoniate is not available, is too costly or medically contraindicated.

Cutaneous leishmaniasis

Leishmaniasis is a vector-borne disease caused by an obligate intracellular protozoa, Leishmania, which resides in macrophages. The parasite is transmitted by an infected female sandfly. The incidence of cutaneous leishmaniasis approaches 2 million new cases per year with 90% of the cases occurring in the "Old World", while the "New World" accounts for the rest. Infection may be restricted to the skin with development of characteristic ulcers, or may affect the mucous membranes in its mucocutaneous form. The clinical diagnosis is verified by the presence of amastigotes in slit-skin smears. Therapeutic modalities include systemic treatments such as the pentavalent antimony compound sodium stibogluconate, liposomal formulations of amphotericin B, oral ketoconazole or itraconazole, as well as topical paromomycin sulphate, local heat, freezing with liquid nitrogen, or photodynamic therapy. An effective vaccine is not available.

Leishmaniasis cutánea crónica: respuesta a n-metil glucamina intralesional tras fracaso con paramomicina tópica

Abstract.—The cutaneous leishmaniasis is one of the most important causes of chronic cutaneous ulcers in the mediterranean coast.We present the case of a 87-year-old woman that consulted for an eccematous lesion on the forehead of eigth-month duration whose histologycal study was diagnostic of leishmaniasis. The patient was treated with riphampicin and later with 15% paramomycin topically without success, so we used intralesional n-metil glucamin with healing of the lesion in two months.The treatment of election of the cutaneous leishmaniasis is pentavalent antimonial (in a parenteral or intralesional way). We discuss the effectiveness of the treatment topical paromomycin to 15%.

Tinidazole therapy for metronidazole-resistant vaginal trichomoniasis.

Treatment of patients with metronidazole-refractory vaginal trichomoniasis constitutes a major therapeutic challenge, and treatment options are extremely limited. Although the majority of patients infected with trichomonads, who demonstrate reduced in vitro susceptibility to metronidazole, respond to high-dose but poorly tolerated regimens of metronidazole, clinical failure is by no means uncommon. We report a cure rate of 22 (92%) of 24 patients with refractory trichomoniasis treated with high doses of oral and vaginal tinidazole. This series included 15 cases with increased in vitro minimal lethal concentration values of metronidazole. Tinidazole, despite the high doses used, was extremely well tolerated, with few side effects. Topical paromomycin was effective in 7 (58%) of 12 patients treated, but frequent local vulvovaginal adverse reactions precluded extensive use. Widespread reports of metronidazole resistance and limited treatment options emphasize the need for additional trichomonacidal agents.

Managing Resistant Trichomonas Vaginitis.

Vaginal trichomoniasis is a sexually transmitted disease of worldwide importance that is commonly treated with metronidazole. Although surprisingly uncommon, resistance to metronidazole has nevertheless been widely reported. Patients with suspected resistant trichomoniasis should have the diagnosis confirmed either by visualization of motile trichomonads on saline microscopy or by culture. In addition, reinfection from a partner must be ruled out through a careful history. Data regarding treatment of metronidazole-resistant trichomoniasis are mainly limited to case reports or series. Most cases can be treated successfully with increasing doses of oral metronidazole. Other promising options include oral tinidazole and topical paromomycin cream.

Cutaneous leishmaniasis due to Leishmania infantum. Case reports and literature review.

Leishmania infantum recently has been identified as a possible agent of cutaneous leishmaniasis (CL). This species has been isolated from cutaneous lesions of patients from the Mediterranean Basin. However, little is known about the clinical, biological, or therapeutic features of this newly recognized CL. Six patients aged 9 months to 85 years in southeastern France were found to have autochthonous leishmaniasis. Parasitological identification showed that the agent was L infantum, zymodemes Montpellier-1 for 2 patients and Montpellier-24 for 1 patient. Five patients who underwent testing with a Western blot assay were found to have antibodies against 4 antigens with molecular masses of 18, 21, 23, and 31 kd. Five patients were successfully treated with local injections of N-methylglucamine, and 1 patient was successfully treated with topical paromomycin sulfate. No patient had visceral disease at diagnosis or after follow-up. Recent data provide increasing evidence that L infantum is an important agent of CL. In southwestern Europe, this species is the only agent that has long been identified from autochthonous CL. Leishmania infantum should be considered an agent of CL in areas in which visceral leishmaniasis is endemic. Western blot assay could be a useful test for the diagnosis, but precise parasitological identification is important to having a better knowledge of the disease. The relationships between CL and the visceral disease have to be explored.

Metronidazole resistant trichomoniasis successfully treated with paromomycin.

Management of a 42 year old female patient diagnosed with trichomoniasis is described. She failed to respond to recommended oral and high dose oral and topical metronidazole. Various options used...

Non-ulcerative cutaneous leishmaniasis in Honduras fails to respond to topical paromomycin

A double-‘blind’, placebo-controlled trial of topical therapy with 15% paromomycin (aminosidine) and 10% urea in white paraffin was carried out on 53 patients with non-ulcerating cutaneous leishmaniasis in Honduras. Although the treatment was not effective, several unexpected findings emerged from the trial. Leishmania mexicana was found to be the cause of many of the skin lesions in one of the 2 study sites. These lesions were clinically indistinguishable from those caused by L. chagasi, the aetiologic agent previously found for this form of leishmaniasis. This is the first documented report of L. mexicana in Honduras.

Treatment of New World cutaneous and mucosal leishmaniases

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%)-MBCI (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.

Topical treatment of New World cutaneous leishmaniasis in Belize: A clinical study

Many studies have been performed during the past decade to find an effective topical therapy for cutaneous leishmaniasis (CL). Our purpose was to evaluate the effect of paromomycin ointment (P-ointment) containing 15% paromomycin sulfate and 12% methylbenzethonium chloride on Belizean patients with New World CL. Fifty-three patients were treated twice daily for 14 to 21 days with P-ointment. Sixty-eight percent of the patients healed, 6% had a delayed cure, and 26% did not respond. No toxic effects from the ointment were observed. Topical paromomycin is as efficacious in the treatment of New World CL as other currently accepted modalities that are potentially more toxic.

EFFECT OF TOPICAL PAROMOMYCIN ON CELL‐MEDIATED IMMUNITY DURING CUTANEOUS LEISHMANIASIS

The aim of this study was to evaluate the effect of topical paromomycin treatment on the development of immunity during cutaneous leishmaniasis. Three parameters of immunity were measured in the course of the disease: leishmanicidal effector activity, lymphocyte proliferation (cell-mediated immunity), and antibody levels (humoral immunity). Peripheral blood specimens of 55 treated and 36 untreated patients were tested. The main results of this study showed that there was a significant delay in the development of leishmanicidal effector activity and to a lesser extent also a delay in the development of antigen-specific proliferative response in the treated compared with the untreated group. No difference was observed between the groups regarding the values achieved in the various tests. These results suggest that topical paromomycin treatment delays the development of cell-mediated immunity but does not affect the levels of immunity that are eventually achieved.

Topical treatment of Old World cutaneous leishmaniasis caused by Leishmania major: A double-blind control study

A controlled study of the efficacy of topical paromomycin sulfate (PR) and methylbenzethonium chloride (MBCl) in cutaneous leishmaniasis (CL) has not yet been performed. The therapeutic effect of an ointment containing 15% PR and either 12% or 5% MBCl (15/12 or 15/5 P-ointment) on patients suffering from Old World CL was examined in a randomized, double-blind, cross-over study. Thirty-nine patients with Old World CL caused by Leishmania major were treated topically, twice daily, for 10 to 20 days with 15/12 or 15/5 P-ointment and 10 to 20 days with a placebo ointment to achieve a total of 30 days of treatment in all groups. In the P-ointment-treated groups, 74.2% (29 of 39 patients) of the patients were cured versus 26.6% (4 of 15 patients) in the placebo-treated group. Little difference was found between the 15/12 and 15/5 P-ointment groups. In most of the patients treated with the active ingredients, total elimination of the parasites was achieved within the first 10 days of treatment.