The authors stated that 54 studies were included in the review (n=2,969). Twelve RCTs that compared different drugs were included in meta-analysis.
The authors stated that more than 80 per cent of studies had moderate to high quality.
Unless specifically stated otherwise, response rates reported below were from uncontrolled studies.
Pentavalent antimonials: The overall cure rate for patients with primary cutaneous leishmaniasis was 76.5 per cent (23 studies, n=1,133). For patients receiving 20 doses of 20 mg/kg/day of meglumine there were no differences in response between different Leishmania species (L. brasiliensis, L. amazonensis and L. guyanensis). Results differed across different regions (71.3 per cent in Brazil and 91.4 per cent in Columbia). Meglumine and stibogluconate showed similar response rates (both 76.5 per cent).
Paromomycin: For patients infected with any Leishmania species pentavalent antimonials (20 mg/kg/20 days) had lower response rates than pentamidine (4 mg/kg/7 days) with 77 per cent versus 87 per cent, p<0.05. However, meta-analysis of four studies that directly compared the two drugs showed no significant difference. For patients who failed to respond to initial treatment with pentavalent antimonials, pentamidine was associated with a higher response rate than re-treatment with pentavalent antimonials (87.2 per cent versus 63.6 per cent, p<0.05).
Other drugs: Cure rates were reported as 38 per cent for intravenous paromomycin (n=106) and 78 per cent for topical paromomycin. Meta-analysis of controlled studies showed significantly higher response rates for antimonials compared to allopurinol (three studies, OR.31, 95% CI: 0.18, 0.55), topical aminoglycosides (paromomycin, OR 0.25, 95% CI: 0.12, 0.49), intravenous paromomycin (OR 0.55, 95% CI: 0.31, 0.99) and imidazole agents (two studies, OR 0.02, 95% CI: 0.01, 0.09). The number of studies of each form of paromomycin was not clear.