The authors stated that 54 studies were included in the review (2,969 patients). 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, 1,133 patients). For patients receiving 20 doses of 20mg/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% in Brazil and 91.4% in Columbia). Meglumine and stibogluconate showed similar response rates (both 76.5%).
Paromomycin: For patients infected with any Leishmania species pentavalent antimonials (20mg/kg/20 days) had lower response rates than pentamidine (4mg/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% versus 63.6%, p<0.05).
Other drugs: Cure rates were reported as 38 per cent for intravenous paromomycin (106 patient) and 78 per cent for topical paromomycin. Meta-analysis of controlled studies showed significantly higher response rates for antimonials compared to allopurinol (OR.31, 95% CI 0.18 to 0.55; three studies), topical aminoglycosides (paromomycin, OR 0.25, 95% CI 0.12 to 0.49), intravenous paromomycin (OR 0.55, 95% CI 0.31 to 0.99) and imidazole agents (OR 0.02, 95% CI 0.01 to 0.09; two studies). The number of studies of each form of paromomycin was not clear.