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Low efficacy of azithromycin to treat cutaneous leishmaniasis in Manaus, AM, Brazil Azitromicina para tratamento de leishmaniose cutânea em Manaus, AM, Brasil

By Alan César Teixeira, Marcilene Gomes Paes, Jorge de Oliveira Guerra, Aluízio Prata and Mario León Silva-Vergara

Abstract

An open trial to evaluate the azithromycin efficacy in cutaneous leishmaniasis patients was carried out in Manaus (AM), where Leishmania (Viannia) guyanensis is the main etiologic agent. Forty-one patients with skin lesions of less than 12 weeks duration, without specific treatment for the last three months and a positive imprint to Leishmania sp. were included. From these, 31 (75.6%) were male with median age of 30.2. All of them received a daily-single oral dose of 500 mg of azithromycin for ten days. At 25th day, 16 (39%) presented therapeutic failure and received intramuscular pentavalent antimonial, four were considered lost, 21, that had improved or were inaltered received another ten-day series of azithromycin and were monthly followed, but nine (21.9%) of them presented a poor clinical response and switched to intramuscular pentavalent antimonial on day 55. Of the 12 remaining cases evaluated on day 55, despite of clinical improvement, three asked for antimony therapy and 9 (21.9%) continued the follow-up but, only three were cured on 55th, 85th and 115th days, and six did not come back for final evaluation. The intention-treatment overall response rate was 22% and whole cure was seen in three (7.3%) of cases. Thus, azithromycin showed a low efficacy to treat cutaneous leishmaniasis in Manaus.<br>Para avaliar a eficácia da azitromicina na leishmaniose cutânea, foi realizado ensaio clínico em Manaus, Amazonas, onde o agente etiológico predominante é a Leishmania (Viannia) guyanensis. Incluídos 41 pacientes com lesões de menos de 12 semanas, sem história de tratamento específico nos últimos três meses e com esfregaço positivo para Leishmania sp. Destes, 31 (75,6%) eram masculinos, idade média 30,2 anos. Todos receberam azitromicina 500 mg em dose única oral, diária, por 10 dias. No dia 25º, 16 (39%) pioraram e receberam antimonial pentavalente via intramuscular por 20 dias e, 21 (61%) que apresentaram melhora da lesão ou esta permanecia inalterada no 25º dia, receberam outro ciclo de 10 dias de azitromicina e foram acompanhados mensalmente. Destes, nove (21,9%) apresentaram piora das lesões na avaliação do dia 55 e iniciaram tratamento com antimonial neste dia. Dos 12 que permaneceram no estudo, porque tinham melhorado clinicamente, três optaram por tratamento com antimonial pentavalente no 55º dia e três apresentaram reepitelização completa das lesões nos dias 55º, 65º e 115º. Seis pacientes não retornaram para avaliação final. Análise por tentativa de tratamento foi 22% e cura confirmada em três (7,3%) casos. Estes resultados mostraram que azitromicina tem baixa eficácia para tratar leishmaniose em área onde a Leishmania (Viannia) guyanensis é o agente etiológico predominante

Topics: Azithromycin, Cutaneous leishmaniasis, Antimony, Leishmania (Viannia) guyanensis, LCC:Medicine (General), LCC:R5-920, LCC:Medicine, LCC:R, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: Instituto de Medicina Tropical
Year: 2007
DOI identifier: 10.1590/S0036-46652007000400008
OAI identifier: oai:doaj.org/article:51647e2544a142e493304f4b5e1fd2ac
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