Mesa Redonda Leishmaniose Tegumentar Avanos no tratamento

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Mesa Redonda Leishmaniose TegumentarAvanços no
tratamento
Armando Schubach Fiocruz / RJ Instituto de
Pesquisa Clínica Evandro Chagas Laboratório de
Vigilância em Leishmanioses vigileish_at_ipec.fiocruz
.br
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Revisão da Literatura
Tuon et al. Treatment of New World cutaneous
leishmaniasis a systematic review with a
meta-analysis. Int J Dermatology 47109-124,
2008 ... Fifty-four articles met our inclusion
criteria and 12 were included in the
meta-analysis. Pentavalent antimonials were the
most studied drugs, with a total of 1150
patients, achieving a cure rate of 76.5. The
cure rate of pentamidine was similar to that of
pentavalent antimonials. Other drugs showed
variable results, and all demonstrated an
inferior response... ... Nevertheless, several
aspects, such as cost, adverse effects, local
experience, and availability of drugs to treat
CL, must be considered when determining the best
management of this disease, especially in
developing countries where resources are
scarce...
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Revisão da Literatura
Amato et al. Treatment of Mucosal Leishmaniasis
in Latin America Systematic Review. Am J Trop
Med Hyg 77266-274, 2007   ... few drugs have
emerged over the past 40 years. Drug resistance
has increased, and the cure rate is no better
than 70 in the largest studies... ...22 articles
met our inclusion criteria. Stibogluconate
achieved a 51 cure rate (76/150 patients), and
88 of patients treated with meglumine were cured
(121 patients). Pentamidine and amphotericin were
as effective as meglumine. Use of ... other
therapies ... was controversial... ...Cost,
adverse effects, local experience, and
availability of drugs to treat ML are strong
points to be considered before determining the
best management of this disease, especially in
developing countries.
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Orientações do Manual LTA SVS / MS, 2007

• No Brasil, o antimoniato de meglumina é a droga
  de escolha para tratamento inicial da LTA
• Recomendações do Ministério da Saúde (máximo 3
  ampolas / dia)
• LC 10-20 mg Sb5/kg/dia IM ou IV 20 dias
• LM 20mg Sb5/kg/dia IM ou IV 30 dias
• Se não cicatrizar completamente após 12 semanas
  do término do tratamento, repetir o esquema

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• Em caso de não resposta, utilizar droga de
  segunda escolha
• Anfotericina B 0,3-0,5mg/Kg/dia e aumentar
  até 1mg/Kg/dia (máximo 50mg/dia ). Dose total LC
  (1-1,5g), LM (2,5-3g) e LV (1-3g). Necessidade de
  ambiente hospitalar.
• Pentamidina 2-4mg/Kg, IM, dias alternados,
  5 a 25 semanas. O MS recomenda não ultrapassar 2g
  total. Pode causar diabetes insulino-dependente.

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Tratamento dos casos de LTA 1998-2008
Laboratório de Vigilância em Leishmanioses
(Vigileish) Instituto de Pesquisa Clínica
Evandro Chagas (IPEC)Fiocruz / RJ
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Conclusões

• O antimoniato de meglumina, em diferentes
  esquemas terapêuticos, mostrou-se eficaz
• A anfotericina B (desoxicolato e lipossomal)
  revelou-se uma excelente opção terapêutica
• A pentamidina foi utilizada com sucesso como
  droga de terceira linha