Treatment of cutaneous leishmaniasis with a topical antileishmanial drug (WR279396): phase 2 pilot study.

We studied the efficacy of WR279396, a topical formulation of aminoglycosides that cures 100% of cutaneous leishmaniasis lesions in mice. We conducted what is to our knowledge the first controlled study of WR279396 therapy for clinical cutaneous leishmaniasis. A total of 45 Colombian soldiers, all men, were randomly assigned to treatment with WR279396 (33 patients) or placebo (12 patients). Each lesion was treated twice daily for 20 days. Lesions were measured at the end of therapy and at 45, 90, and 180 days after treatment began. A total of 17 (61%) of 28 assessable WR279396-treated patients were cured, and 5 (55%) of 9 assessable placebo-treated patients were cured (P = 0.9). For the 36 lesions treated with WR279396 that were cured, cure took a mean of 35 days, whereas for the 6 lesions that were cured in the group of patients receiving placebo, cure time took a mean of 56 days (P = 0.04). WR279396 is a nontoxic topical formulation that significantly accelerated cure time in patients with Leishmania panamensis cutaneous leishmaniasis.

Resistencia in vitro de Shigellas de Lima Metropolitana / In vitro Shigella resistance in Lima Metropolitana

Del 15 de noviembre de 1989 al 15 de enero de 1991 (14 meses) recolectamos 214 cepas de Shigella de 8 Laboratorios de Lima Metropolitana, predominando S. flexneri con el 61.7 por ciento. Aplicando el método de disco-difusión estandarizado para el antibiograma, se utilizaron discos de amikacina, ampicilina, cloranfenicol, ácido nalidíxico, norfloxacina, sulfadiazina, cotrimoxazol y tetraciclina. Encontramos resistencia a tetraciclina, 90.7 por ciento; ampicilina, 89.7 por ciento; cloranfenicol, 79.4 por ciento; sulfadiazina, 73.8 por ciento; cotrimoxazol, 34.1 por ciento; amikacina, 7.9 por ciento ácido nalidíxico, 0 por ciento y norfloxacina, 0 por ciento. El 89.7 por ciento de las cepas de Shigella fueron resistentes a 2 o más antimicrobianos. El patrón de resistencia más identificado fue a 5 de los antimicrobianos: AM: C, SD, STX, TE con la prevalencia de 26.5 por ciento. Todas las S. sonnei y S. boydii presentaron algún tipo de resistencia, mientras que S. dysenteriae el 94.1 por ciento y S. flexneri el 97 por ciento. La resistencia de Shigella aisladas en Lima ha sido en aumento en los últimos años, manteniéndose sensibles a las quinolonas, las cuales podrían ser el tratamiento de elección. Se enfatiza como medida preventiva lavarse las manos después de ir al baño y antes de manipular alimentos.

Two hundred and fourteen Shigella strains were isolated from patiens in eight laboratories in Metropolitan Lima from 15 November 1989 to 15 January 1991(14 months). S. flexneri was the predominant strain with 61. 7 per cent. Amikacin, ampicillin, chloramphenicol, nalidixic acid, norfloxacin, sulfadiazine, cotrimoxazol and tetracycline discs were used in the standardized disc- diffusion method for the susceptibility test. The strains were found to be resistant to tetracycline, 90.7 per cent; ampicillin, 89.7 per cent; choloramphenicol, 79.4 per cent;sulfadiazine, 73.8 per cent; cotrimaxol, 34.1 per cent; amikacin, 7.9 per cent; nalidixic acid, 0 per cent norfloxazin, 0 per cent. 89.7 per cent of the Shigella strains resistant to two or more antimicrobials.The most often identified resistance pattern was to 5 of the antimicrobials: AM, C, SD, STX, TE with a 26.2 per cent prevalence. All S. sonnei and S. boydii presented some type of resitance, whereas. S. dysenteriae showed 94.1 per cent and S. flexneri 97 per cent. Resistance from Shigella isolated in Lima has increased in the last years, athough they have sensitive to quinolones. Thus, quinolones may be the treatment of choice. Handwashing after and before using the bathroom or manipulating food is strongly enphasized as a preventive measure