Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study.
PLoS Negl Trop Dis
; 17(1): e0011029, 2023 01.
Article
em En
| MEDLINE
| ID: mdl-36689465
ABSTRACT
BACKGROUND:
Treatment guidance for children and older adult patients affected by cutaneous leishmaniasis (CL) is unclear due to limited representation of these groups in clinical trials.METHODS:
We conducted a collaborative retrospective study to describe the effectiveness and safety of antileishmanial treatments in children ≤ 10 and adults ≥ 60 years of age, treated between 2014 and 2018 in ten CL referral centers in Latin America.RESULTS:
2,037 clinical records were assessed for eligibility. Of them, the main reason for non-inclusion was lack of data on treatment follow-up and therapeutic response (182/242, 75% of children and 179/468, 38% of adults). Data on 1,325 eligible CL patients (736 children and 589 older adults) were analyzed. In both age groups, disease presentation was mild, with a median number of lesions of one (IQR 1-2) and median lesion diameter of less than 3 cm. Less than 50% of the patients had data for two or more follow-up visits post-treatment (being only 28% in pediatric patients). Systemic antimonials were the most common monotherapy regimen in both age groups (590/736, 80.2% of children and 308/589, 52.3% of older adults) with overall cure rates of 54.6% (95% CI 50.5-58.6%) and 68.2% (95% CI 62.6-73.4%), respectively. Other treatments used include miltefosine, amphotericin B, intralesional antimonials, and pentamidine. Adverse reactions related to the main treatment were experienced in 11.9% (86/722) of children versus 38.4% (206/537) of older adults. Most adverse reactions were of mild intensity.CONCLUSION:
Our findings support the need for greater availability and use of alternatives to systemic antimonials, particularly local therapies, and development of strategies to improve patient follow-up across the region, with special attention to pediatric populations.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Leishmaniose Cutânea
/
Antiprotozoários
Tipo de estudo:
Guideline
/
Observational_studies
Limite:
Aged
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Child
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Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article