Triple therapy for acute and chronic cutaneous leishmaniasis using oral zinc sulfate, oral ketoconazole and topical podophyllin

Triple therapy for cutaneous leishmaniasis

Abstract

Background Cutaneous Leishmaniasis is endemic in many countries thus it is major health problem. There are many therapeutic agents like topical,intralesional and oral drugs but might be associated with failure rates and emergence of resistant strains as intralesional and systemic sodium stibogluconate showed high failure figures with significant side effects. Objective To determine the efficacy of triple therapy using oral zinc sulfate and oral ketoconazole and topical podophyllin in the treatment of cutaneous Leishmaniasis. Patients and methods This is  therapeutic study that was conducted during the period, March 2019 to December 2021 where 230 patients with acute and chronic cutaneous leishmaniasis were enrolled in this study. The diagnosis was confirmed by smear and histopathology. . All patients were treated by oral zinc sulfate(5-10mg/kg/ day in divided doses) while oral ketoconazole was given 200mg twice a day for adults and 100mg for young children and 50-75mg a day for infants according to the body weight(3.3-6.6 mg/kg/day).Topical 25% podophyllin solution was applied once a week. The duration of therapy was continued up to 6 weeks to be seen every two weeks until complete cure, then monthly for the next three months as follow up period.To assess the response to therapy ,Sharquie’s modified Leishmania was applied. Results The analysis of 230 patients with cutaneous leishmaniasis showed that their ages ranged from 6months- 60 years with a mean of 27 years with 120(52.17%) males and110(47.82 %) females. All patients mentioned that response was started after a week but on examination, was obvious after two weeks and complete clearance after 6 weeks. After completion of the treatment, the cure rate was 99%. No important adverse effects were noticed in any patients but gastric irritation was seen in some patients receiving zinc sulfate and skin burning in some patients using podophyllin. Conclusions Triple therapy of cutaneous leishmaniasis using oral zinc sulfate and ketoconazole and topical podophyllin was effective in treatment of acute and chronic leishmaniasis although every single therapy is effective but aiming to increase the effectiveness especially in chronic cases and to avoid failure of treatment No important systemic and local adverse reactions were recorded.