Systemic Ivermctine plus Inralesional Antimony Compared with Antimony Alone in Treatment of Cutaneous Leishmaniasis

Abstract

Background: About (1.5 million) cases of CL annually all-over the world, there are many treatment strategies are applicable; some are topical other is systemically given
Rationale: Many management modalities are of good final result, but the durable effect might be of golden hope for the patients.
Aim: Estimate the effectiveness of intralesional sodium Stibo-gluconate (ILSSG) augmented by orally administered Ivermctine to decrease the number of injection sessions and its complications, increase the efficacy of pentavalent antimony, shorten the therapy duration and minimize or prevent the resultant scar.
Methodology: An evaluative prospective study had been conducted from September 2018 to the march of 2020 to recruit eighty nine patients with typical cutaneous leishmaniasis, who visiting the outpatients of dermatology and Venereology in Al-Hussein Teaching hospital- Thi-Qar province. After full consent, two groups, well crossly matched regarding age, gender, the type and size of the lesions: group a received ILSSG plus oral Ivermctine weekly and group B who received ILSSG weekly alone.
Results: high rate of complete response in group A in six week (81.39%) compared to 1st week (2.23%) when it compared with group B which was with very good response rate in 6th week (67.39%) while no response in 1st week. The complete response A and B was relatively equal (93.02%) and (91.3%) respectively in third month. The highest rate of partial response was observed in the first week 16(37.20%) and then reduced in the third week (27.90%) and sixth week (16.27%) while the percentage of reduction of group B- partial response in was higher than group A as a compared group. The group A -poor responses were (60.46%), (9.30%) and (2.32%) in the 1st, 3rd, 6th week respectively, which showing obvious decrement, while group B -poor responses were high especially in the week (97.82%) and (43.47%) first and third week respectively. There was significant statistical difference in response rate within the 1st and 3rd weeks of follow-up, while 6th week and 3rd months which showing the differences in response rate.
Conclusion: Addition of Ivermctine as Combined type of treatment show early good and partial response than ILSSG alone with significant durable effect.