we have a case of cutaneous leishmaniasis and planned to treat with injection SSG over lesion with mechanical heat therapy but unfortunately we could not get SSG in the center. Need expert opinion with evidence.
The German wikipedia page ( https://de.wikipedia.org/wiki/Leishmaniose ) reports about a topical medication with a cream with 15 % Paromomycin - once per day for 20 days. This is the result from a US/Tunesian study from 2013.
(Healing quote: 81 % after 98 days.)
I could locate the reference: doi:10.1056/NEJMoa1202657
But in that article only ulcerated cutaneous lesions were included but this case is little different being this is solitary cutaneous non-ulcerated lesion.
We have discussed the case with the team of dermatologist and tropical medicine specialist from our institution and some expert from other and even gone through national protocol to manage the leishmaniasis. Now it has been concluded to start with the slow intravenous liposomal amphotericin B infusion at the dose of 5 mg per Kg body weight for three days with total dose of 15 mg per kg over three days through dextrous.
Being the SSG is old drug and not available in our setting also liposomal amphotericin B is noval drug with only few minor adverse effects we concluded to this.
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