Treatment of mucosal lesions of the upper respiratory and digestive tractsof patients with American Tegumentary Leishmaniasis with low doses (5mg sb 5+/ kg/day) of Meglumine Antimoniate

Os antimoniais pentavalentesem doses de 10 a 20mg Sb 5+ /kg/dia continuam sendo o tratamento de escolha para a leishmaniose tegumentar americana (LTA), apesar dos relatos de baixa efetividade e de elevado n??mero de efeitos adversos, inclusive ??bito. Este estudo teve como objetivo descrever a efetividade e a seguran??a do antimoniato de meglumina 5mg Sb 5+ /Kg/dia no tratamento de pacientes com a forma mucosa ou mucocut??nea (LM/LMC) da LTA, ao longo de dezesseis anos, no Instituto de Pesquisa Cl??nica Evandro Chagas (IPEC), Funda????o Oswaldo Cruz, Rio de Janeiro, Brasil. Foi realizado um estudo descritivo e retrospectivo, tipo s??rie de casos acompanhados longitudinalmente. Os dadosforam obtidos dos prontu??rios dos pacientes com LM/LMC atendidos no Servi??o de Otorrinolaringologia do IPEC entre 1?? de janeiro de 1989 e 31 de dezembro de 2004 e tratados com baixa dose de antimoniato de meglumina, de forma cont??nua ou intermitente (em s??ries com intervalos de descanso). Dos 1667 pacientes com LTA tratados nesse per??odo, 148 (8,9%) apresentavam LM/LMC. Destes, 98 (66,2%) tratados com antimoniato de meglumina 5mg Sb 5+ /Kg/dia foram inclu??dos neste estudo. A maioria dos pacientes eram homens que desempenhavam atividades de risco para LTA na regi??o Sudeste do Brasil. A apresenta????o cl??nica mais frequente foi a forma mucosa tardia com acometimento nasal. Os pacientes submetidos ao tratamento em s??ries eram na maioria mais velhos e, possivelmente, com mais co-morbidades. Ambos os esquemas terap??uticos apresentaram boa efetividade com reduzido n??mero de efeitos adversos. Mesmo nos pacientes com necessidade de retratamento, estes esquemas se mantiveram bem tolerados e eficazes. Os pacientes que foram tratados com anfotericina B ou alta dose de antimoniato de meglumina ap??s o tratamento com baixa dose, responderam adequadamente. O tratamento com antimoniato de meglumina 5mg Sb 5+ /Kg/dia se mostrou efetivo e bem tolerado no tratamento da LM/LMC, com 91,7% de cura, mesmo que tendo sido necess??rio mais de um tratamento.Pentavalent antimonials in 10 to 20mg Sb 5+ /kg/day doses are still the first drug of choice for American tegumentary leishmanisis (ATL) treatment despite reports of low efficiency and high number of adverse effects,including death. This study aims at describing the efficiency and safety of 5mg Sb 5+ /Kg/day of meglumine antimoniate in treating patients with mucous or mucocutaneous (ML/MCL) ATL over sixteen years at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation, Rio de Janeiro, Brasil. A retrospective and descriptive studywas conducted with a longitudinal surveillance of a series of cases. Datawere obtained from medical records of patients with ML/ MCL treated at IPEC Otorhinolaringology Department between January 1 st, 1989 and December 31, 2004 with low doses of meglumine antimoniate applied continuously or intermittently (in series with rest intervals). From a total of 1667 patients with ATL treated over that period, 148 (8.9%) presented ML/MCL. From those, 98 (66.2%) treated with 5mg Sb 5+ /Kg/day of meglumine antimoniate were included in the present study. Most patients were men who performed activitieswith risk for ATL in Southeastern Brazil. The most frequent clinical presentation was late mucousal impairment with nasal involvement. Patients undergoing serial treatment were mostly older and possibly with more co-morbidities.Both therapeutic plans presented good efficiency with few adverse effects. Even in patients needing retreatment, these therapeutic plans were well tolerated and efficient. Patients treated with anphotericin B or high dose of meglumine antimoniate,after treatment with low dose, presented an adequate response. Treatment of ML/MCL with 5mg Sb 5+ /Kg/day meglumine antimoniate was effective and well tolerated, with 91.7% healing, even when more than one treatment was needed