CORRESPONDENCE Topical Paromomycin/Methylbenzethonium Chloride Plus Parenteral Meglumine Antimonate as Treatment of American Cutaneous Leishmaniasis: Controlled Study

SIR—We congratulate Soto and colleagues [1] for their interesting study, because to our knowledge it is the first controlled trial assessing the effect of topical paromomycin/methylbenzethonium chloride (MBCL) in combination with meglumine antimonate as treatment of New World cutaneous leishmaniasis. This study did not show any additional therapeutic effect of the ointment in combination with parenteral meglumine antimonate, which con-tradicts findings of earlier studies in which high cure rates were associated with treatment with the ointment alone or in combina-tion with meglumine antimonate [2, 3]. Soto et al. argue that this difference may be due to a better controlled study design. Al-though this point is undoubtedly true, a number of concerns should be kept in mind. Our experience is that MBCL causes pain of the lesion so that even applying placebo ointment would not allow an adequat