Funding sources This study was a World Health Organization-aided SEARO/TDR Small Grant Programme Project T/16/72/83/IND SN1164. Miltefosine capsules were supplied by the National Vector Borne Diseases Control Programme of the Department of Health, Government of India. Partial financial support was provided by the Indian Council of Medical Research, New Delhi, India. G.K.K. and S.V. received fellowships from the Council for Scientific and Industrial Research, India.
Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis
Article first published online: 20 JUL 2011
© 2011 The Authors. BJD © 2011 British Association of Dermatologists 2011
British Journal of Dermatology
Volume 165, Issue 2, pages 411–414, August 2011
How to Cite
Ramesh, V., Katara, G.K., Verma, S. and Salotra, P. (2011), Miltefosine as an effective choice in the treatment of post-kala-azar dermal leishmaniasis. British Journal of Dermatology, 165: 411–414. doi: 10.1111/j.1365-2133.2011.10402.x
Conflicts of interest None declared.
- Issue published online: 20 JUL 2011
- Article first published online: 20 JUL 2011
- Accepted manuscript online: 11 MAY 2011 09:16AM EST
- Accepted for publication 26 April 2011
Background Post-kala-azar dermal leishmaniasis (PKDL) constitutes a parasite reservoir important in the transmission of visceral leishmaniasis (VL). Unacceptable treatment regimens and increasing drug resistance blight control programmes. The success of oral miltefosine in VL prompted a clinical, histopathological and parasitological study of this drug in PKDL.
Objectives To define the dose and duration of miltefosine for treatment of PKDL.
Methods Twenty-six patients confirmed by slit-skin smear, histopathology and molecular tests were enrolled in the study. They received miltefosine capsules 50 mg thrice daily after food. Treatment was for 60 days with a provision to increase by 30 days if a responder had not attained a cure. Cure was ascertained by clinical and histopathological examination, and measuring parasite burden using real-time polymerase chain reaction.
Results Twenty-four patients with a wide range of parasite burden completed the study. Twenty-three achieved a cure giving an initial cure rate of 96% (95% confidence interval 79–99%). Sixteen patients were cured with 50 mg thrice daily, 13 in 60 days and three within 90 days. In seven cases, miltefosine had to be reduced, because of gastrointestinal intolerance, to 50 mg twice daily to a total of 180 capsules. Lesional parasites were undetectable at 1 month post-treatment. Treatment was safe with no relapses at 1-year follow-up.
Conclusion Oral miltefosine, 50 mg thrice daily for 60 days or twice daily for 90 days, could be an effective treatment for PKDL.