Paromomycin sulfate is an aminoglycoside antibiotic that until recently was used in parasitology only for oral therapy of intestinal parasitic infections (see previous text). It has recently been developed for the treatment of visceral leishmaniasis. It is much less expensive than amphotericin or miltefosine. A trial in India showed excellent efficacy, with a daily intramuscular dosage of 11 mg/kg for 21 days yielding a 95% cure rate, and noninferiority compared with amphotericin. However, a recent trial showed poorer efficacy in Africa, with the cure rate for paromomycin significantly inferior to that with sodium stibogluconate. In initial studies, paromomycin was well tolerated, with common mild injection pain, uncommon ototoxicity and reversible liver enzyme elevations, and no nephrotoxicity. Paromomycin has also shown good efficacy when topically applied, alone or with gentamicin, for the treatment of cutaneous leishmaniasis.
Drug Combinations Used in the Treatment of Visceral Leishmaniasis
The use of drug combinations to improve treatment efficacy, shorten treatment courses, and reduce the selection of resistant parasites has been an active area of research. In a recent trial in India, compared to a standard 30-day (treatment on alternate days) course of amphotericin, noninferior efficacy and decreased adverse events were seen with a single dose of liposomal amphotericin plus a 7-day course of miltefosine, a single dose of liposomal amphotericin plus a 10-day course of paromomycin, or a 10-day course of miltefosine plus paromomycin. In a trial in East Africa, compared to a standard 30-day course of sodium stibogluconate, similar efficacy was seen with a 17-day course of sodium stibogluconate plus paromomycin.
Artemether/lumefantrine Coartem, Riamet
Atovaquone Generic, Mepron
Chloroquine Generic, Aralen
Clindamycin Generic, Cleocin
Doxycycline Generic, Vibramycin
Eflornithine Vaniqa, Ornidyl
Iodoquinol Diquinol, Yodoxin
Mefloquine Generic, Lariam
Metronidazole Generic, Flagyl
Paromomycin Generic, Humatin
Pentamidine Pentam 300, Pentacarinat, pentami-dine isethionate, Nebupent (aerosol)
Tinidazole Generic, Tindamax *Available in the USA only from the Drug Service, CDC, Atlanta, Georgia (phone: 404-639-3670; www.cdc.gov/laboratory/drugservice/).
Kappagoda S, Singh U, Blackburn BG: Antiparasitic therapy. Mayo Clin Proc 2011;86:561.
Medical Letter: Drugs for parasitic infections. Med Lett Drugs Ther 2013;Supplement.
Ashley EA et al: Tracking Resistance to Artemisinin Collaboration (TRAC). Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 2014;371:411.
Baird KJ, Maguire JD, Price RN: Diagnosis and treatment of Plasmodium vivax malaria. Adv Parasitol 2012;80:203.
Boggild AK et al: Atovaquone-proguanil: Report from the CDC expert meeting on malaria chemoprophylaxis (II). Am J Trop Med Hyg 2007;76:208.