Topical Paromomycin for Cutaneous Leishmaniasis in Bolivia

Fundacion Nacional de Dermatologia

Status and phase: Completed; Phase 3; Phase 2

Conditions: Leishmaniasis, American; Leishmaniasis; American, Cutaneous; Leishmaniasis, Cutaneous; Leishmania Braziliensis Complex

Treatments: Drug: Paromomycin Sulfate; Other: Placebo; Drug: Pentamidine Isethionate

Study type: Interventional

Funder types: Other

Identifiers

NCT03096457

ABF-BO-2016-102

Details and patient eligibility

About

This protocol will compare topical paromomycin to standard intralesional (IL) antimony (Sb) to placebo for L braziliensis in Bolivia.

Full description

Patients will be randomized between Paromomycin cream applied topically once daily for 20 days (group 1--40 patients), pentamidine administered intralesionally at 120 ug/mm2 on days 1, 3, 5 (group 2-20 patients), and cream vehicle applied topically once daily for 20 days (group 3-20 patients).

After treatment, all patients will be followed for 1, 3, and 6 months.

Enrollment: 80 patients

Sex: All

Ages: 12+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Gender: Male or female
• Age: >12 yrs of age
• Presentation: 1-to-2 ulcerative lesions, each < 30 mm in largest diameter and with a total lesion area <900 mm2.
• Parasitology: Parasitological confirmation of the lesion will be made by visualization or culture of Leishmania from the biopsy or aspirate of the lesion.

Exclusion criteria

• Previous treatment for leishmaniasis with Sb, pentamidine, amphotericin B, miltefosine, imidazoles, allopurinol in the last 3 months.
• Other diseases that would be likely in the PI's opinion to interact, either positively or negatively, with treatment.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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80 participants in 3 patient groups, including a placebo group

Group 1 - Paromomycin cream

Experimental group

Description:

40 subjects will be included to receive 15% paromomycin in aquafilm base twice a day during 20 consecutive days. The lesion will be cleaned , then, a generous amount of the study drug (an amount sufficient to cover the area of the ulcer and the lesion border) will be applied to the lesion and rubbed into the ulcer using a gloved finger by a member of the clinical study staff. After application of the study drug, the patient will be observed for 15 minutes for signs of adverse events. If there are no signs of local toxicity, the area of the ulcer will be covered with extra study drug. For Days 2-20, the study drug will be applied and the lesion covered with a sterile gauze and tape dressing as on Day 1.

Treatment:

Drug: Paromomycin Sulfate

Group 2. Local Injectable Pentamidine

Active Comparator group

Description:

20 subjects will be included to receive IL pentamidine \[Pentacarinat® Sanofi-Aventis: 30 mg/ml\] will administered at a dose of 120 ug (4 ul) per mm2 of lesion area 3 times (on days 1, 3, and 5) as per our previous experience. A small button of Xylocaine® will be applied by means of a thin needle at the four cardinal points of the lesion and then a small gauge (23g) needle will introduce the drug in each cardinal point. The needle will be moved in all directions to infiltrate of whole lesion and surrounding infiltrated area.

Treatment:

Drug: Pentamidine Isethionate

Group 3. Vehicle control

Placebo Comparator group

Description:

10% Urea en parafilm cream will be used in similar ways as paromomycin cream in group 1

Treatment:

Other: Placebo