Treatment for cutaneous leishmaniasis caused by Leishmania braziliensis, using 15% paromomycin-Aquaphilic, was superior to a negative vehicle control and comparable in efficacy to a positive control, according to a randomized control study ( identifier: NCT03096457) published in Clinical Infectious Diseases.

In this study, cure rates after 6 months of follow-up were reported for 40 patients treated with 15% paromomycin in Aquaphilic vs 20 patients treated with Aquaphilic vehicle vs 20 patients treated with the positive control, intralesional pentamidine. Cure rates for paromomycin were 77.5% (95% CI, 62.5%-88%), 10% (95% CI, 3%-30%) for Aquaphilic vehicle (P < .0001 vs paromomycin-Aquaphilic), and 70% (95% CI, 48%-85.5%) for the positive control. Grade 1 adverse reactions occurred in only 5% to 10% of patients treated with paromomycin-Aquaphilic and the Aquaphilic vehicle.

The wider application of these results remains in question because of the modest study size and the fact that treatment for only a single species causing New World cutaneous leishmaniasis was tested. However, according to investigators, “this formulation appears superior to placebo against a mild, prevalent cause of Old World [cutaneous leishmaniasis] and against an aggressive, prevalent cause of New World [cutaneous leishmaniasis],” and the treatment is well tolerated. The primary disadvantage compared with the current local intervention of intralesional injections is the requirement of daily administration for 20 days.

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The investigators welcomed further evaluation of 15% paromomycin-Aquaphilic, and concluded that these results enlarge the potential use of this treatment for cutaneous leishmaniasis in general.

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Soto J, Soto P, Ajata A, et al. Topical 15% paromomycin-Aquaphilic for Bolivian Leishmania braziliensis cutaneous leishmaniasis: A randomized, placebo-controlled trial [published online September 27 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy619