Treatment of cutaneous leishmaniasis with antimony: intramuscular versus intralesional administration

The various methods used to treat cutaneous leishmaniasis (CL) have not given consistent results. The aim of the present study was to compare the efficacy of a solution of meglumine antimoniate (MA; 85 mg Sb/ml) given intralesionally (i.l.) with that of the same solution given intramuscularly (i.m.). Eighty CL patients, with a total of 147 lesions, were randomly allocated into the two treatment groups. Forty were injected i.m. with MA (15 mg Sb/kg.day) on 6 days/week until 12 injections had been given to each. The lesions of the other 40 patients were infiltrated with MA (0.2-0.8 ml/lesion) every other day for 30 days. After 15 days' therapy, none of the lesions on those treated i.m. had fully healed (although five lesions showed some improvement) whereas two lesions on those treated i.l. had fully healed and 10 showed good improvement. After 30 days, 46 (68%) of the 68 lesions on those treated i.m. had healed completely, 11 (16%) had improved, and five (8%) worsened. The corresponding values for the 66 lesions on those treated i.l. were 48 (73%), 10 (15%) and three (5%). There was no statistically significant difference between the two treatment groups, either in terms of satisfactory response (lesions fully healed or improved) or unsatisfactory response (lesions unchanged or advanced), when assessed on day 30 (P > 0.5). Intralesional antimony is a rapidly effective, safe and economical method of treating simple CL, particularly in patients with cardiac, liver or renal disease, for whom antimonials are contra-indicated.