A species-specific approach to the use of non-antimony treatments for cutaneous leishmaniasis.

We used a species specific approach to treat 10 patients with cutaneous leishmaniasis diagnosed using polymerase chain reaction Non-antimony treatments (oral miltefosine, ketoconazole, and liposomal amphotericin B) were chosen as an alternative to pentavalent antimony drugs based on likely or proven drug efficacy against the infecting species Letshmania Viannia panamensis was diagnosed in three patients and treated successfully with oral ketoconazole Miltefosine treatment cured two patients with L infantum chagasi A wide variety of Leishmania responded to liposomal amphotericin B administered for 5-7 days Three patients with L V braziliensis, one patient with L tropica, and two patients with L infantum chagasi were treated successfully One person with L V braziliensis healed slowly because of a resistant bacterial superinfection and a second patient with L infantum chagasi relapsed and was retreated with miltefosine These drugs were reasonably well-tolerated In this limited case series, alternative non antimony based regimens were convenient, safe, and effective