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Treatment of Old World Cutaneous Leishmaniasis by Pentamidine Isethionate

Background: Pentavalent antimonial derivatives (PAD), especially meglumine antimoniate (Glucantime®), are usually considered as the first-line drugs for Old World leishmaniasis, but their potential toxicity and the number of required injection, either intralesional or intramuscular, prompt to search for alternative treatments. Objective: To evaluate the efficiency and tolerance of pentamidine isethionate in Old World leishmaniasis. Methods: An open pilot study included 11 patients from two regional academic centers, with varied parasitological forms of Old World leishmaniasis, treated with three strictly intramuscular injections of 4 mg/kg of base-pentamidine every other day. Results: Tolerance was good overal, and 8/11 (73%) of patients responded well with a quick healing of their lesions, little scarring and no relapse. Conclusion: Pentamidine isethionate is a safe and effective first-line treatment for Old World leishmaniasis. Larger-scale prospective studies comparing several dosage regimens of pentamidine and pentamidine isethionate to PAD are warranted.