局部涂敷巴龙霉素(霸龙霉素涂肤剂)
一项 III 期随机、赋形剂对照临床试验表明,每天局部涂敷一次巴龙霉素软膏且连续涂敷 20 天(联用或不联用庆大霉素)可以有效地治疗由硕大利什曼原虫感染引起的皮肤利什曼病患者。[139]Ben Salah A, Ben Messaoud N, Guedri E, et al. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med. 2013;368:524-532.http://www.ncbi.nlm.nih.gov/pubmed/23388004?tool=bestpractice.com每天局部涂敷一次巴龙霉素软膏、联用庆大霉素且连续涂敷 20 天的治疗方案对感染巴拿马利什曼原虫患者的疗效高于单独涂敷软膏但不联用庆大霉素的治疗方案。[140]Sosa N, Capitán Z, Nieto J, et al. Randomized, double-blinded, phase 2 trial of WR 279,396 (paromomycin and gentamicin) for cutaneous leishmaniasis in Panama. Am J Trop Med Hyg. 2013;89:557-563.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771300/http://www.ncbi.nlm.nih.gov/pubmed/23857024?tool=bestpractice.com涂敷部位会出现轻度至中度反应,[139]Ben Salah A, Ben Messaoud N, Guedri E, et al. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med. 2013;368:524-532.http://www.ncbi.nlm.nih.gov/pubmed/23388004?tool=bestpractice.com[140]Sosa N, Capitán Z, Nieto J, et al. Randomized, double-blinded, phase 2 trial of WR 279,396 (paromomycin and gentamicin) for cutaneous leishmaniasis in Panama. Am J Trop Med Hyg. 2013;89:557-563.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771300/http://www.ncbi.nlm.nih.gov/pubmed/23857024?tool=bestpractice.com巴龙霉素组的发生率要高于赋形剂对照组。[139]Ben Salah A, Ben Messaoud N, Guedri E, et al. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med. 2013;368:524-532.http://www.ncbi.nlm.nih.gov/pubmed/23388004?tool=bestpractice.com
口服抗真菌药
一些医生会使用口服吡咯抗真菌药治疗局限性皮肤利什曼病,以代替其他药物,但是仅限于感染特定利什曼原虫虫种的患者。仅建议对感染墨西哥利什曼原虫、巴拿马利什曼原虫和硕大利什曼原虫的患者使用此类治疗方法,但不建议感染巴西利什曼原虫或热带利什曼原虫的患者使用此类治疗方法。[141]Saenz RE, Paz H, Berman JD. Efficacy of ketoconazole against Leishmania braziliensis panamensis cutaneous leishmaniasis. Am J Med. 1990;89:147-155.http://www.ncbi.nlm.nih.gov/pubmed/2166429?tool=bestpractice.com[142]Navin TR, Arana BA, Arana FE, et al. Placebo-controlled clinical trial of sodium stibogluconate (Pensostam) versus ketoconazole for treating cutaneous leishmaniasis in Guatamala. J Infect Dis. 1992;165:528-534.http://www.ncbi.nlm.nih.gov/pubmed/1311351?tool=bestpractice.com[143]Alrajhi AA, Ibrahim EA, De Vol EB, et al. Fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major. N Engl J Med. 2002;346:891-895.http://www.nejm.org/doi/full/10.1056/NEJMoa011882http://www.ncbi.nlm.nih.gov/pubmed/11907288?tool=bestpractice.com支持性数据极少。由于已知墨西哥利什曼原虫和硕大利什曼原虫具有较高的自愈率,因此未来有必要进行安慰剂对照研究。