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Clin Infect Dis. 2017 Jan 1;64(1):67-71. Epub 2016 Nov 1.

Fluconazole in the Treatment of Cutaneous Leishmaniasis Caused by Leishmania braziliensis: A Randomized Controlled Trial.

Author information

1
Serviço de Imunologia, Hospital Universitário Prof Edgard Santos, Universidade Federal da Bahia.
2
Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais.
3
Centro de Pesquisa Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil.

Abstract

BACKGROUND:

 The treatment of cutaneous leishmaniasis (CL) caused by Leishmania braziliensis in Brazil with pentavalent antimony (Sbv) is associated with a high rate of failure, up to 45% of cases. In addition, Sbv can only administered parenterally and has important toxic effect. An effective, safe, and oral treatment for CL is required.

METHODS:

 A randomized controlled clinical trial was conducted to compare the efficacy and safety of high-dosage oral fluconazole (6.5-8.0 mg/kg/d for 28 days) versus a standard Sbv protocol (20 mg/kg/d for 20 days) for the treatment of CL in Bahia, Brazil.

RESULTS:

 A total of 53 subjects were included in the trial; 26 were treated with Sbv, and 27 with fluconazole. Intention-to-treat analysis showed initial cure rates (2 months after treatment) of 22.2% (6 of 27) in the fluconazole and 53.8% (14 of 26) in the Sbv group (P = .04). Six months after treatment, the final cure rate remained the same in both groups, without any relapses. The frequencies of adverse effects in the Sbv and fluconazole groups were similar, 34.6% versus 37% respectively. One patient treated with fluconazole discontinued treatment owing to malaise, headache, and moderate dizziness (Common Terminology Criteria for Adverse Events grade 2).

CONCLUSIONS:

 Oral fluconazole at a dosage of 6.5-8 mg/kg/d for 28 days should not be considered an effective treatment for CL caused by L. braziliensisClinical Trials Registration. NCT01953744.

KEYWORDS:

Leishmania (V.) braziliensis; cutaneous leishmaniasis; fluconazole; pentavalent antimony

PMID:
27803094
DOI:
10.1093/cid/ciw662
[Indexed for MEDLINE]

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