Leishmania panamensis cutaneous leishmaniasis — what to do when local treatment did not achieve healing

Clinical scenario

This protocol applies to patients with cutaneous leishmaniasis specifically caused by Leishmania panamensis in whom the initial course of local therapy has not resulted in complete reepithelialization of the lesion.

Prior treatment failure

First-line local therapy — topical paromomycin/methylbenzethonium chloride ointment or local heat therapy — did not achieve the required goal: complete reepithelialization (healing) of the cutaneous lesion. Non-achievement of this target is the criterion that triggers escalation to the current protocol.

Next-step approach

Following local treatment failure, the structured protocol defines systemic treatment as the next step, with specific options addressing cases involving multiple lesions or a large single lesion — the full regimen, selection criteria, and sequencing are in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jtm.12089

Treatment of L. panamensis
1. Miltefosine (50 mg tid × 28 days) [A]
2. Pentamidine isethionate (4 mg/kg, three infusions over 5 days) [A]
3. Ketoconazole (600 mg × 28 days) [B]
4. Pentavalent antimonials (Sb 20 mg/kg for 20 days) [A]
Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.

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