Self-application of aminoglycoside-based creams to treat cutaneous leishmaniasis in travelers.

• Main Authors: Oussama Mouri (Author), Cléa Melenotte (Author), Romain Guéry (Author), Camille Cotteret (Author), Arnaud Schweitzer-Chaput (Author), Alice Perignon (Author), Marc Thellier (Author), Emmanuelle Bourrat (Author), Florentia Kaguelidou (Author), Jean Yves Siriez (Author), Denis Malvy (Author), Jean-Pierre Gangneux (Author), Alexandre Duvignaud (Author), Christophe Ravel (Author), Salvatore Cisternino (Author), Janet Ransom (Author), Eric Caumes (Author), Olivier Lortholary (Author), Max Grogl (Author), Pierre Buffet (Author)
• Format: Book
• Published: Public Library of Science (PLoS), 2023-08-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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&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.<h4>Discussion</h4>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.

Item Description

1935-2727
1935-2735
10.1371/journal.pntd.0011492