Ayelet Ollech, Michal Solomon, Amir Horev, Shiran Reiss-Huss, Dan Ben-Amitai, Alex Zvulunov, Rivka Friedland, Vered Atar-Snir, Vered Pessach-Molho, Aviv Barzilai, Shoshana Greenberger
DOI: 10.2340/00015555-3669

Cutaneous leishmaniasis poses a therapeutic challenge in the paediatric population. The aim of this study was to assess the efficacy and safety of miltefosine treatment for Old World cutaneous leishmaniasis in paediatric patients. A multicentre retrospective review of 10 children (≤ 18 years of age) with cutaneous leishmaniasis treated with miltefosine in Israel was performed. Mean ± standard deviation age at diagnosis was 9.1 ± 5.0 years. The Leishmania species diagnosed was L. tropica in 8 cases and Leishmania major in 2 cases. Mean ± standard deviation duration of treatment was 44.8 ± 20.6 days, with a mean follow-up period of 12.1 ± 17.1 months. Complete response was noted in 8 (80%) patients. Treatment failure was noted in 2 (20%) cases. Side-effects related to the medication were minimal. In conclusion, oral miltefosine may be an effective and safe treatment for Old World cutaneous leishmaniasis caused by Leishmania tropica or Leishmania major in children. However, further studies are warranted to draw a definite conclusion.

Treatment options for cutaneous leishmaniasis warranting systemic therapy in the paediatric population include sodium stibogluconate and liposomal amphotericin B. Both of these are intravenous formulations with potentially significant side-effects. There are limited reports on the use of miltefosine in the treatment of Old World cutaneous leishmaniasis in children. In this case series of 10 paediatric patients with recalcitrant cutaneous leishmaniasis caused by Leishmania tropica and Leishmania major species, treat­ment with oral miltefosine was effective in 80% of patients. The oral route of administration was favourable for the patients, with minimal side-effects.