[Tropmed-l] Chromoblastomycosis 100 years

Thu Apr 23 15:00:44 BRT 2015

Dear Dr. Flavio: to my knowledge there aren't Randomized Controlled Studies comparing Lipidic formulations of Amphotericin in patients with MCL.

For our guide I guess is useful the expert's revisions performed in 2010 (WHO) and 2011-2013 (PAHO) about Treatment of Leishmaniasis.

Best regards

Dr. Tomás A. Orduna

Jefe de Servicio
Patologías Regionales y Medicina Tropical (CEMPRA-MT)
Hospital de Infecciosas F. J. Muñiz
Uspallata 2272 (C.P. 1282)
Buenos Aires - Argentina
T.E.:Conmutador:(+54-11) 4305-0357/1944 (ext. 231)
Fax: (+54-11) 4305-3161
torduna at intramed.net<mailto:torduna at intramed.net>

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WHO Technical Report Series

949

CONTROL OF THE LEISHMANIASES

Report of a meeting of the

WHO Expert Committee on the

Control of Leishmaniases,

Geneva, 22–26 March 2010

Lipid formulations of amphotericin B

Several formulations, including liposomal amphotericin B, amphotericin B

lipid complex and amphotericin B colloidal dispersion, have been used in

treatment. They are similar to amphotericin B deoxycholate in their efficacy

but are significantly less toxic. They are given by intravenous infusion over

2 h. Mild infusion reactions (fever, chills and rigor) and back pain occur in

some patients. Transient nephrotoxicity or thrombocytopenia is occasionally

seen. Most clinical trials have been conducted with a reference liposomal

amphotericin B formulation; all other lipid formulations should be evaluated

for toxicity, bioequivalence and efficacy before they are used clinically.

Mucosal leishmaniasis

New World mucocutaneous leishmaniasis: The treatment options for mucocutaneous

leishmaniasis are summarized in Box 4. The treatment outcome

depends on the location of the lesions. High cure rates are obtained when the

lesions are limited to the nose and mouth; when the larynx, vocal cords and

trachea are involved, however, the cure rates after therapy with systemic antimonials

are low, and relapse and recurrence are frequent after clinical

improvement and apparent cure. The scarcity of amastigotes and the difficulty

of culture usually complicate parasitological monitoring.

Pentavalent antimonials: Cure rates after treatment with pentavalent

antimonials range from 30% to 100%, depending on the location of

lesions and the geographical area (Evidence C). The current regimen is 20 mg/

kg per day for 30 days.

Amphotericin B deoxycholate: A regimen of 20–45 doses of 0.7–1.0

mg/kg was 80–90% effective (Evidence C) but requires intravenous infusion and

strict follow-up of renal function.

Liposomal amphotericin B: Liposomal amphotericin B at a dose of

2–3 mg/kg for at least 20 days gave similar cure rates as and fewer

adverse events than amphotericin B deoxycholate (Evidence C).

Pentamidine: There are limited data on use of pentamidine, but it can

be considered as an alternative treatment (Evidence C).

Miltefosine: In Bolivia, the cure rate of mucocutaneous leishmaniasis

(L. braziliensis) under miltefosine (2.5–3.3 mg/kg per day for 4 weeks)

was 83% in patients with mild disease and 58% in patients with more

extensive disease. The cure rates did not improve when therapy was

prolonged from 4 to 6 weeks (Evidence B).

A combination of oral pentoxyfylline plus pentavalent antimonials for

30 days reduced the relapse rate and accelerated cure in comparison

with pentavalent antimonials alone (Evidence A).

OPS-PAHO
LEISHMANIASIS EN LAS AMÉRICAS
RECOMENDACIONES PARA EL TRATAMIENTO
Washington, D.C.: OPS, 2013.

[cid:c9ddca07-e1b4-446f-82ca-7554d848d4d5]

________________________________
De: tropmed-l-bounces at lineu.icb.usp.br <tropmed-l-bounces at lineu.icb.usp.br> en nombre de Flavio Queiroz Telles <queiroz.telles at uol.com.br>
Enviado: domingo, 07 de diciembre de 2014 11:58
Para: jeffrey shaw; TropMed-L
Asunto: Re: [Tropmed-l] Chromoblastomycosis 100 years

Dear All

I am looking for some evidence about the use of the lipid formulations oaf Ampho B (ABELCET and AMBISOME) for the therapy of refractory or intolerant mucocutaneous leishmaniasis?
Is there any published controlled clinical trial?
Bets Regards
Flavio Queiroz-Telles
Federal University of Parana, Brazil

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