Self-application of aminoglycoside-based creams to treat cutaneous leishmaniasis in travelers
RAVEL, Christophe
Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle [MIVEGEC]
Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle [MIVEGEC]
CISTERNINO, Salvatore
Optimisation thérapeutique en Neuropsychopharmacologie [OPTeN (UMR_S 1144 / U1144)]
Hôpital Necker - Enfants Malades [AP-HP]
Optimisation thérapeutique en Neuropsychopharmacologie [OPTeN (UMR_S 1144 / U1144)]
Hôpital Necker - Enfants Malades [AP-HP]
LORTHOLARY, Olivier
Hôpital Necker - Enfants Malades [AP-HP]
Centre d'infectiologie Necker-Pasteur [CHU Necker]
Imagine - Institut des maladies génétiques (IHU) [Imagine - U1163]
Hôpital Necker - Enfants Malades [AP-HP]
Centre d'infectiologie Necker-Pasteur [CHU Necker]
Imagine - Institut des maladies génétiques (IHU) [Imagine - U1163]
GROGL, Max
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas [CIBERINFEC]
Hospital Universitario 12 de Octubre [Madrid]
< Réduire
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas [CIBERINFEC]
Hospital Universitario 12 de Octubre [Madrid]
Langue
EN
Article de revue
Ce document a été publié dans
PLoS Neglected Tropical Diseases. 2023-08-10, vol. 17, n° 8, p. e0011492
Résumé en anglais
Background: In endemic foci, the use of an aquaphilic cream containing paromomycin with/without gentamicin to treat cutaneous leishmaniasis (CL) is safe, painless and cures 78-82% of patients with New and Old World CL. ...Lire la suite >
Background: In endemic foci, the use of an aquaphilic cream containing paromomycin with/without gentamicin to treat cutaneous leishmaniasis (CL) is safe, painless and cures 78-82% of patients with New and Old World CL. Self-application in travelers requires evaluation.Methods: Travelers with 1-10 lesions of confirmed CL were prospectively treated with the paromomycin-gentamicin formulation (WR279396, 2012-2017, Group 1) and carefully follow up, or treated with a locally produced paromomycin-only cream (2018-2022, Group 2). The cream was applied once under supervision, then self-applied daily for 20-30 days. A cured lesion was defined as 100% re-epithelialization at day 42 without relapse at three months. Results: Medical features were similar in Group 1 (17 patients), and Group 2 (23 patients). Patients were infected with either Leishmania major, L. infantum, L. killicki, L. guyanensis, L. braziliensis, or L. naiffi. Intention-to-treat and per-protocol cure rates were 82% (95% confidence interval (CI) [64.23;100.00]) and 87% (95% CI [71,29;100.00]) in Group 1, and 69% (95% CI [50.76; 88.37]) and 76% (95% CI [57.97; 94.41]) in Group 2. In the pooled Group 1 and 2, 75% (95% CI [61.58;88.42]) (30/40) and 81% (95% CI [68,46;93.6]) (30/37) of patients were cured in intention-to-treat and per-protocol, respectively. There were no significant differences observed in the success rates between Old World and New World CL (83.3% vs. 60%, p = 0.14). Prospective observations in Group 1 showed that adverse events were mainly pruritus (24%) and pain (18%) on lesions (all mild or moderate). No mucosal involvement was observed in either group.Discussion: In this representative population of travelers who acquired CL either in the Old or New World, the 81% per-protocol cure rate of a self-applied aminoglycoside cream was similar to that observed in clinical trials.< Réduire
Unités de recherche