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Previous Volume 346:891-895 March 21, 2002 Number 12 Next

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ABSTRACT

Background Whereas certain oral antifungal azoles are well documented to have activity against leishmania, data on the efficacy of fluconazole for leishmaniasis are limited. We conducted a controlled trial in Saudi Arabia of fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major.

Methods This randomized, double-blind, placebo-controlled trial assessed the efficacy of oral fluconazole, in a dose of 200 mg daily for six weeks, in the treatment of parasitologically confirmed cutaneous leishmaniasis. The primary outcome measure was the time to the complete healing of all lesions.

Results A total of 106 patients were assigned to receive fluconazole, and 103 patients were assigned to receive placebo. Follow-up data were available for 80 and 65 patients, respectively. At the three-month follow-up, healing of lesions was complete for 63 of the 80 patients in the fluconazole group (79 percent) and 22 of the 65 patients in the placebo group (34 percent; relative risk of complete healing, 2.33 [95 percent confidence interval, 1.63 to 3.33]). According to an intention-to-treat analysis, the rates of healing were 59 percent and 22 percent, respectively (relative risk, 2.76 [95 percent confidence interval, 1.84 to 4.12]). Sodium stibogluconate was offered to 11 patients in the fluconazole group who returned for follow-up (14 percent) and 33 of those in the placebo group (51 percent) in whom oral treatment was judged to have failed. According to a Kaplan–Meier analysis, the time to healing was shorter for the fluconazole group (median, 8.5 weeks, as compared with 11.2 weeks in the placebo group; P<0.001 by the log-rank test). Side effects were mild and similar in both groups.

Conclusions A six-week course of oral fluconazole is a safe and useful treatment for cutaneous leishmaniasis caused by L. major.

Source Information

From the Department of Immunology and Infectious Diseases, Harvard School of Public Health, and the Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital — both in Boston (A.A.A., J.H.M.); and the Ministry of Health of Saudi Arabia (E.A.I., M.K., R.M.F.); the Section of Infectious Diseases, Department of Medicine (A.A.A.), and the Department of Biostatistics, Epidemiology, and Scientific Computing (E.B.D.V.), King Faisal Specialist Hospital and Research Centre — both in Riyadh, Saudi Arabia.

Address reprint requests to Dr. Alrajhi at the Department of Medicine, MBC No. 46, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia.

Full Text of this Article

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Fluconazole for the Treatment of Cutaneous Leishmaniasis
Zvulunov A., Klaus S., Vardy D., Alrajhi A. A., De Vol E. B., Maguire J. H.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:370-371, Aug 1, 2002. Correspondence

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