Article    Table of Contents                    Full Text of this article Free    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Velez, I.    Berman, J.    Related Articles in PubMed    PubMed Citation    PubMed

ABROAD

Inefficacy of Allopurinol as Monotherapy for Colombian Cutaneous Leishmaniasis

A Randomized, Controlled Trial

Ivan Velez, MD, MSc; Sonia Agudelo, Med Tech; Erik Hendrickx, MD, MSc; Juan Puerta, Med Tech; Max Grogl, PhD; Farrohk Modabber, PhD; and Jonathan Berman, MD, PhD

1 February 1997 | Volume 126 Issue 3 | Pages 232-236

Background: Hundreds of thousands of cases of cutaneous leishmaniasis occur each year worldwide. Available therapies are parenteral, moderately toxic, and costly.

Objective: To determine the efficacy of and tolerance for oral allopurinol as monotherapy for cutaneous leishmaniasis.

Design: Randomized, controlled trial.

Setting: Outpatient clinics in 11 regions of Colombia in which cutaneous leishmaniasis is endemic.

Patients: 187 otherwise healthy adults with cutaneous leishmaniasis. Eighty-four percent of patients were infected with or were from regions with Leishmania panamensis; 16% were infected or were from regions with L. braziliensis.

Intervention: Patients were randomly assigned to one of three treatment groups. The first group received allopurinol, three 100-mg tablets four times daily (20 mg/kg of body weight per day) for 28 days. The second group received three placebo tablets four times daily for 28 days. The third group received Glucantime, 20 mg of intramuscular antimony/kg per day for 20 days.

Measurement: Complete cure was defined as complete clinical reepithelialization of all lesions at 3 months and no relapse during 12 months of follow-up.

Results: Of 182 patients whose data could be analyzed, 157 (86%) were evaluated. In the allopurinol group, 18 of 55 (33% [95% CI, 21% to 47%]) patients were cured; in the placebo group, 17 of 46 patients (37% [CI, 23% to 52%]) were cured (difference, 4% [CI, –14% to 22%]; P = 0.68); and in the Glucantime group, 52 of 56 patients (93% [CI, 83% to 98%]) were cured (P < 0.001 compared with the allopurinol and placebo groups combined). In most cases, therapy was considered to have failed because the lesion did not reepithelialize by 1.5 months after the end of therapy. Three cases of relapse (two in the allopurinol group and one in the placebo group) at the nasal mucosa (mucosal leishmaniasis) had occurred by the end of 12 months of follow-up.

Conclusions: Allopurinol monotherapy has no effect on Colombian cutaneous disease primarily caused by L. panamensis and therefore is unlikely to be effective against cutaneous leishmaniasis in other endemic regions.

This article has been cited by other articles:

				A. LLANOS-CUENTAS, J. ECHEVARRIA, C. SEAS, E. CHANG, M. CRUZ, E. ALVAREZ, E. ROSALES, P. CAMPOS, and A. BRYCESON PARENTERAL AMINOSIDINE IS NOT EFFECTIVE FOR PERUVIAN MUCOCUTANEOUS LEISHMANIASIS Am J Trop Med Hyg, June 1, 2007; 76(6): 1128 - 1131. [Abstract] [Full Text] [PDF]

				G. MORIZOT, P. DELGIUDICE, E. CAUMES, E. LAFFITTE, P. MARTY, A. DUPUY, C. SARFATI, S. HADJ-RABIA, H. DARIE, A.-S. LE GUERN, et al. HEALING OF OLD WORLD CUTANEOUS LEISHMANIASIS IN TRAVELERS TREATED WITH FLUCONAZOLE: DRUG EFFECT OR SPONTANEOUS EVOLUTION? Am J Trop Med Hyg, January 1, 2007; 76(1): 48 - 52. [Abstract] [Full Text] [PDF]

				M. I. Al-Salabi and H. P. de Koning Purine Nucleobase Transport in Amastigotes of Leishmania mexicana: Involvement in Allopurinol Uptake Antimicrob. Agents Chemother., September 1, 2005; 49(9): 3682 - 3689. [Abstract] [Full Text] [PDF]

				J. SOTO, J. TOLEDO, J. VEGA, and J. BERMAN SHORT REPORT: EFFICACY OF PENTAVALENT ANTIMONY FOR TREATMENT OF COLOMBIAN CUTANEOUS LEISHMANIASIS Am J Trop Med Hyg, April 1, 2005; 72(4): 421 - 422. [Abstract] [Full Text] [PDF]

				E. M. ANDERSEN, M. CRUZ-SALDARRIAGA, A. LLANOS-CUENTAS, M. LUZ-CJUNO, J. ECHEVARRIA, C. MIRANDA-VERASTEGUI, O. COLINA, and J. D. BERMAN COMPARISON OF MEGLUMINE ANTIMONIATE AND PENTAMIDINE FOR PERUVIAN CUTANEOUS LEISHMANIASIS Am J Trop Med Hyg, February 1, 2005; 72(2): 133 - 137. [Abstract] [Full Text] [PDF]

				J. SOTO, L. VALDA-RODRIQUEZ, J. TOLEDO, L. VERA-NAVARRO, M. LUZ, H. MONASTERIOS-TORRICO, J. VEGA, and J. BERMAN COMPARISON OF GENERIC TO BRANDED PENTAVALENT ANTIMONY FOR TREATMENT OF NEW WORLD CUTANEOUS LEISHMANIASIS Am J Trop Med Hyg, November 1, 2004; 71(5): 577 - 581. [Abstract] [Full Text] [PDF]

				J. R. Ramírez, S. Agudelo, C. Muskus, J. F. Alzate, C. Berberich, D. Barker, and I. D. Velez Diagnosis of Cutaneous Leishmaniasis in Colombia: the Sampling Site within Lesions Influences the Sensitivity of Parasitologic Diagnosis J. Clin. Microbiol., October 1, 2000; 38(10): 3768 - 3773. [Abstract] [Full Text]

				T.K. Jha, S. Sundar, C.P. Thakur, P. Bachmann, J. Karbwang, C. Fischer, A. Voss, and J. Berman Miltefosine, an Oral Agent, for the Treatment of Indian Visceral Leishmaniasis N. Engl. J. Med., December 9, 1999; 341(24): 1795 - 1800. [Abstract] [Full Text] [PDF]

				M. Hueso, J. Bover, D. Seron, S. Gil-vernet, G. Rufi, J. Alsina, and J. M. Grinyo The renal transplant patient with visceral leishmaniasis who could not tolerate meglumine antimoniate--cure with ketoconazole and allopurinol Nephrol. Dial. Transplant., December 1, 1999; 14(12): 2941 - 2943. [Full Text] [PDF]