I. Becker et al., The efficacy of pentamidine combined with allopurinol and immunotherapy for the treatment of patients with diffuse cutaneous leishmaniasis, PARASIT RES, 85(3), 1999, pp. 165-170
A new treatment regimen was tested on patients with incurable diffuse cutan
eous leshmaniasis (DCL) infected with Leishmania mexicana mexicana in Mexic
o. Two patients with advanced stages of the disease were treated with polyc
hemotherapy (pentamidine and allopurinol) combined with recombinant human i
nterferon-gamma (rIFN-gamma). For determination of the best medication, par
asites isolated from patient lesions were exposed to available drugs both a
s promastigotes and as intracellular amastigotes. A synergistic effect was
observed in vitro for the combination of pentamidine and allopurinol. Both
patients were treated and recovered rapidly, but one of them developed insu
lin-dependent type I diabetes because of pentamidine toxicity. The complica
tion was controlled and both patients were discharged with an apparent para
sitologic cure, but after 3 months the two patients began to relapse. Our r
esults suggest that allopurinol-pentamidine polychemotherapy, involving red
uced dosage of pentamidine, combined with rIFN-gamma is an alternative for
DCL patients infected with L. m. mexicana.