Fluconazole viable treatment for cutaneous leishmaniasis

Sousa AQ. Clin Infect Dis. 2011;53:693-695.

Issue: November 2011

Researchers from Brazil report that high-dose oral fluconazole therapy was well tolerated and had a high cure rate in patients with cutaneous leishmaniasis caused by Leishmania braziliensis.

“I have been working with cutaneous leishmaniasis for many years now, and I am always using pentavalent antimony for its treatment; however, antimony has many side effects and has to be given intramuscularly or intravenously,” Anastácio Q. Sousa, MD, PhD, of the Federal University of Ceará in Brazil, told Infectious Disease News. “Fluconazole is a very good alternative for the treatment of cutaneous leishmaniasis. At a dose of 5 mg/kg daily, 75% patients were cured, and at 8 mg/kg daily, the cure rate was 100%."

From August 2007 to April 2010, Sousa and colleagues assessed the use of high-dose oral fluconazole among 28 patients with a median age of 37.5 years (60% female) with confirmed cutaneous leishmaniasis caused by L. braziliensis.

Patients were treated with escalating doses, from 5 mg/kg daily to 8 mg/kg daily, and evaluated after 4 weeks of treatment. Among those who responded to treatment, evaluations were performed every 2 weeks; fluconazole was continued until skin lesions were completely healed.

Twenty-five patients were cured within 4 to 12 weeks (median of 6 weeks); three patients were unresponsive to treatment. Compared with 75% of patients cured with 5 mg/kg daily and lesions that were healed within 7.5 weeks, 100% of patients were cured with 8 mg/kg daily; lesions were healed within 4 weeks.

“If we compare the treatment cost of fluconazole with that of antimony, the cost of the former is 12 times lower than that of the latter,” the researchers wrote in the study. “This makes fluconazole a better alternative from an economic standpoint. In summary, the data suggest that fluconazole administered at 8 mg/kg per day for the treatment of cutaneous leishmaniasis due to L. braziliensis is an effective, safe and economically sound option. Additional studies are needed to test the efficacy of high-dose fluconazole against other Leishmania species.” – by Ashley DeNyse

Disclosure: This work was support by CNPq, Brazil (grant 480083/2008-8).

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