Clinical efficacy and pharmacokinetics of antimony in cutaneous leishmaniasis patients treated with sodium stibogluconate.

The efficacy and pharmacokinetics of antimony were explored in 12 young male patients with cutaneous leishmaniasis following intramuscular administration of sodium stibogluconate equivalent to 600 mg of antimony (Sb). Patients' cure rate was evaluated up to 6 weeks after treatment. Blood samples were collected at different time periods on the first and last days of a 3-week treatment. Twenty-four-hour urine samples were also collected on both occasions for the estimation of renal clearance (CL(r)). The blood concentrations of the Sb time profile were best described by a 2-compartment model with a first-order absorption rate. The mean absorption half-life was 0.21 ± 0.023 and 0.36 ± 0.18 hours for the first and last doses, respectively. A rapid distribution phase was followed by a slower elimination phase of a half-life of 9.4 ± 1.9 and 9.69 ± 2.3 hours for both days, respectively. An accumulation index of 2.33 was calculated. The fraction of dose excreted in urine was 0.386 ± 0.11 and 0.326 ± 0.05 on both occasions, respectively. The mean CL(r) was 4.88 ± 1.13 and 4.58 ± 1.05 L/h. In the current study, all of the patients were completely healed by week 6 after the end of treatment, as judged by the treating physician. In conclusion, the blood profile of antimony seems to be multicompartmental in nature.

Effect of chlorpyrifos on healing of cutaneous leishmaniasis lesions after treatment with Pentostam(®).

The insecticide chlorpyrifos (CPF) is widely used in the Kingdom of Saudi Arabia (KSA) to control agricultural pests. The present work is a preliminary investigation of the effect of CPF on healing of cutaneous leishmaniasis (CL) lesions, caused by Leishmania major in farmers exposed to this insecticide, after treatment with Pentostam(®). Lesion diameters were measured and CPF concentrations in the blood plasma of farmer and non-farmer CL patients in Al-Ahsa were detected by gas chromatography/mass spectrometry/mass spectrometry before and 6 weeks after treatment with Pentostam(®). CPF concentrations in the blood of farmer patients ranged between 4.570 and 7.096 ng/µl (mean = 6.19 ± 0.881 ng/µl) before and after treatment with Pentostam(®). The mean lesion diameter in these patients decreased by a factor of 2.21 after treatment with Pentostam(®); they measured 1.85-11.75 mm, (mean = 6.165 ± 3.500 mm) before treatment and 0.22-6.10 mm (mean = 2.796 ± 2.102 mm) after treatment. Lesion diameter increased exponentially with the increase of CPF concentration in the patients' blood. CPF was not detected in the non-farmer patients before or after treatment. Their mean lesion diameter decreased by a factor of 6.86 after treatment with Pentostam(®); they measured 1.33-7.10 mm (mean = 2.882 ± 1.764 mm) before treatment and 0.11-0.92 mm (mean = 0.425 ± 0.277 mm) after treatment. The mean lesion diameter in farmer patients was much greater than that of non-farmer patients both before (2.14×) and after (6.657×) treatment with Pentostam(®). Chronic exposure to low levels of the pesticide aggravates the development and delays the healing of CL lesions due to immunotoxicity and/or peripheral neurotoxicity caused by CPF. Further detailed studies would assess CPF effect on the severity of infection with CL in agricultural workers continuously exposed to this insecticide in different areas of KSA in conformity of their finding.

Treatment trends of cutaneous leishmaniasis in Saudi Arabia.

OBJECTIVES: The aim of this work is to evaluate treatment trends of cutaneous leishmaniasis (CL) in the Kingdom of Saudi Arabia (KSA), which is endemic according to the records of the Ministry of Health (MOH) and the World Health Organization (WHO) indicate so. METHODS: A questionnaire was distributed to dermatologists and general practitioners working at health care centers in different parts of KSA through the Department of Preventive Medicine, Ministry of Health. This questionnaire consisted of 4 categories divided into 10 points covering the patients; demographics, severity of the disease, treatment types and regimen. The response of 107 physicians was included in this study, which covered the period from January-December 2000. RESULTS: The responses of 107 physicians were accepted. Results indicated that there is no consistent method used in treating CL. There were disparities in the type and duration of treatment, in addition there were no differences between treatment of single and multiple lesions. CONCLUSION: Guidelines for treatment of CL must be drawn and a nationwide policy should be implemented taking into consideration all factors that affect the outcome of treatment, such as the strain and susceptibility of the parasite, the severity of the disease as indicated by the size and number of lesions, as well as the patients characteristics such as age, nationality and immune system status.