COMPARISON OF THE EFFICACY OF INTRALESIONAL INJECTIONS OF MEGLUMINE ANTIMONIATE VERSUS METRONIDAZOLE IN PATIENTS PRESENTING WITH CUTANEOUS LEISHMANIASIS AT TERTIARY CARE HOSPITAL, KARACHI

Main Article Content

Abdul Samee
Rabia Ghafoor
Nazia Asad
Bahadur Shah
Rukhsar Ahmed
Marvi Surhiyo

Keywords

Cutaneous leishmaniasis, meglumine antimoniate, glucantim and metronidazole, efficacy

Abstract

Introduction: Cutaneous leishmaniasis (CL) is one of the common parasite disease that affects people. Sand fly bites are the primary mode of transmission for leishmaniasis, which is often identified by a microscope-assisted smear examination of the afflicted region. Pentavalent antimony compounds like sodium stibogluconate and meglumine antimoniate are the preferred therapies for leishmaniasis. Ongoing research is being done to find effective, less hazardous therapies for leishmaniasis, however alternative drugs have been suggested for the disease.


Objective: To compare the efficacy of “intralesional meglumine antimoniate (MA) versus metronidazole” in patients presenting with CL.


Study Design: “Randomized control trial”.


Subjects and methods: All the 60 patients presenting with Cutaneous Leishmaniasis (CL) at the Outpatient Department of Dermatology, JPMC, Karachi during 29-04-21 till 29-10-21 meeting the selection criteria were enrolled. Disease history, demographic information and written informed consent was obtained from study participants. Patients were divided into two groups at random; (A) Intralesional injections of meglumine antimoniate group and (B) Intralesional injections of metronidazole. The procedure was done weekly for a maximum of 8 weeks’ duration and during each visit the lesions was measured in size and photographed again and documented. Efficacy was labeled if patients with Cutaneous Leishmaniasis lesion in either group showed complete response. All the data collected and entered in the pre-designed Performa.


Results: Mean age and duration of CL in the meglumine antimoniate group was 48.21±6.24 years and 1.54±0.78 weeks. Mean age and duration of cutaneous leishmaniasis in the metronidazole group was 49.48±8.41 years and 1.97±0.56 weeks. Efficacy in meglumine antimoniate and metronidazole group was 24 (80%) and 12 (36.7%) respectively.


Conclusion: Meglumine antimoniate injections intralesionally have demonstrated an improved degree of cure in terms of the lesions' decreased size and induration. Treatment for cutaneous leishmaniasis with this approach is painless, simple to use, effective, and has few adverse effects.

Abstract 185 | Pdf Downloads 65

References

1. Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R. Leishmaniasis: a review. F1000Research. 2017;6:750.
2. Yousuf M, Ahmad N, Masood Z, Majeed S, Hassan HU, Ibrahim M, et al. Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan. Brazilian Journal of Biology. 2021;83.
3. Bilgic-Temel A, Murrell DF, Uzun S. Cutaneous leishmaniasis: A neglected disfiguring disease for women. International journal of women's dermatology. 2019;5(3):158-65.
4. Sundar S, Chakravarty J. An update on pharmacotherapy for leishmaniasis. Expert opinion on pharmacotherapy. 2015;16(2):237-52.
5. Maleki M, Yousefi M, Bazzaz SMM, Tabassi SAS, Rakhshandeh H, Hamedi SS, et al. An overview of skin lesions adapted to Cutaneous Leishmaniasis in Persian Medicine. Electronic physician. 2017;9(11):5854-62.
6. Manfredi M, Iuliano S, Bizzarri B, Fugazza A, Gismondi P. Cutaneous leishmaniasis with long duration and bleeding ulcer. Clin Microbiol. 2016;5(229):2.
7. Volpedo G, Pacheco-Fernandez T, Holcomb EA, Cipriano N, Cox B, Satoskar AR. Mechanisms of Immunopathogenesis in Cutaneous Leishmaniasis And Post Kala-azar Dermal Leishmaniasis (PKDL). Frontiers in cellular and infection microbiology. 2021;11:685296.
8. Parkash V, Kaye PM, Layton AM, Lacey CJ. Vaccines against leishmaniasis: using controlled human infection models to accelerate development. Expert review of vaccines. 2021;20(11):1407-18.
9. Reguera RM, Pérez-Pertejo Y, Gutiérrez-Corbo C, Domínguez-Asenjo B, Ordóñez C, García-Estrada C, et al. Current and promising novel drug candidates against visceral leishmaniasis. Pure and Applied Chemistry. 2019;91(8):1385-404.
10. Berbert TRN, Mello TFPd, Wolf Nassif P, Mota CA, Silveira AV, Duarte GC, et al. Pentavalent antimonials combined with other therapeutic alternatives for the treatment of cutaneous and mucocutaneous leishmaniasis: A systematic review. Dermatology research and practice. 2018;2018.
11. Garza-Tovar TF, Sacriste-Hernández MI, Juárez-Durán ER, Arenas R. An overview of the treatment of cutaneous leishmaniasis. Faculty reviews. 2020;9:28.
12. Bamorovat M, Sharifi I, Agha Kuchak Afshari S, Karamoozian A, Tahmouresi A, Heshmatkhah A, et al. Poor adherence is a major barrier to the proper treatment of cutaneous leishmaniasis: A case-control field assessment in Iran. International journal for parasitology Drugs and drug resistance. 2023;21:21-7.
13. Tayyebi M, Darchini-Maragheh E, Layegh P, Kiafar B, Goyonlo VM. The effect of oral miltefosine in treatment of antimoniate resistant anthroponotic cutaneous leishmaniasis: An uncontrolled clinical trial. PLoS neglected tropical diseases. 2021;15(3):e0009241.
14. Heras-Mosteiro J, Monge-Maillo B, Pinart M, Lopez Pereira P, Reveiz L, Garcia-Carrasco E, et al. Interventions for Old World cutaneous leishmaniasis. The Cochrane database of systematic reviews. 2017;12(12):Cd005067.
15. de Oliveira Duque MC, Silva JJQ, Soares PAO, Magalhães RS, Horta APA, Paes LRB, et al. Comparison between systemic and intralesional meglumine antimoniate therapy in a primary health care unit. Acta tropica. 2019;193:176-82.
16. Ullah G, Ali F. The efficacy of intralesional metronidazole compared to intralesional glucantime in the therapeutic therapy of cutaneous leishmaniasis. Journal of Pakistan Association of Dermatologists. 2022;32(2):348-52.
17. Mapar MA, Omidian M. Intralesional injections of metronidazole versus meglumine antimoniate for the treatment of cutaneous leishmaniasis. Jundishapur Journal of Microbiology. 2010;3(2):79-83.
18. Farajzadeh S, Ahmadi R, Mohammadi S, Pardakhty A, Khalili M, Aflatoonian M. Evaluation of the efficacy of intralesional Glucantime plus niosomal zinc sulphate in comparison with intralesional Glucantime plus cryotherapy in the treatment of acute cutaneous leishmaniasis, a randomized clinical trial. Journal of parasitic diseases : official organ of the Indian Society for Parasitology. 2018;42(4):616-20.
19. Kayani B, Sadiq S, Rashid HB, Ahmed N, Mahmood A, Khaliq MS, et al. Cutaneous Leishmaniasis in Pakistan: a neglected disease needing one health strategy. BMC Infectious Diseases. 2021;21(1):622.
20. Sridharan K, Sivaramakrishnan G. Comparative assessment of interventions for treating cutaneous leishmaniasis: A network meta-analysis of randomized clinical trials. Acta Tropica. 2021;220:105944.
21. Kashani MN, Firooz A, Eskandari SE, Ghoorchi MH, Khamesipour A, Khatami A, et al. Evaluation of meglumine antimoniate effects on liver, kidney and pancreas function tests in patients with cutaneous leishmaniasis. European Journal of Dermatology. 2007;17(6):513-5.
22. Somaratne VN, Ranawaka RR, Jayaruwan H, Wipuladasa D, de Silva SP. Randomized, double-blind study on intralesional metronidazole versus intralesional sodium stibogluconate in Leishmania donovani cutaneous leishmaniasis. Journal of Dermatological Treatment. 2019;30(1):87-91.
23. Jaffary F, Nilforoushzadeh MA, Siadat A, Haftbaradaran E, Ansari N, Ahmadi E. A comparison between the effects of glucantime, topical trichloroacetic acid 50% plus glucantime, and fractional carbon dioxide laser plus glucantime on cutaneous leishmaniasis lesions. Dermatology research and practice. 2016;2016.
24. Bahnan BA, Shabu SA, Sleman SA. Intralesional pentostam versus intralesional metronidazole in treating cutaneous leishmaniasis: A comparison study. Zanco Journal of Medical Sciences (Zanco J Med Sci). 2019;23(2):257-63.
25. Javadi A, Khamesipour A, Ghoorchi M, Bahrami M, Khatami A, Sharifi I, et al. Efficacy of intra-lesional injections of meglumine antimoniate once a week vs. twice a week in the treatment of cutaneous leishmaniasis caused by L. tropica in Iran: A randomized controlled clinical trial. PLoS neglected tropical diseases. 2022;16(7):e0010569.

Most read articles by the same author(s)