Treatment of Viscelar Leishmaniasis the Use of allopurinol and ketoconazole

Aim: Leishmania is traditionally treated with pentavalent antimony compounds (Stibogluconate sodium = pentostam, methylglucamine antimonate = Glucanim). Drugs such as pentamidine (Lomidine), liposomal amphotericin B, interferon-γ, granulocyte-macrophage colony-stimulating factor, aminosidine, miltefosine are known to be successful in treatment with or without other drugs in resistant cases to pentavalent antimony compounds. An alternative treatment regimen is the use of drugs such as allopurinol and ketoconazole, which are less toxic. In this study, the efficacy of allopurinol and ketaconazole in combination therapy was investigated. Method: Oral ketoconazole and allopurinol treatment was evaluated in 6 children with visceral leishmania in Mersin University Faculty of Medicine. All the cases were given Allopurinol (20mg / kg / day / 2 doses) and ketoconazole (5mg / kg / day / 2 doses) for 1 month. Result: After one month of treatment, complete remission was observed in four cases, but no remission was achieved in two cases. One of the cases that could not be remitted was diagnosed in another center and was given Glucantim treatment. When fever, fatigue and pallor complained to us, it was evaluated as a relapse on the appearance of leishmania amostigotes in bone marrow. Allopurinol and ketoconazole therapy started. The patient was admitted to treatment with remission and applied to us with the same findings again forty-five days after the end of the treatment. Amphotericin B (3 mg / kg / day) was given as the second relapse. In the other case reactivation occurred in thirty-sixth day after initiation of treatment. Conclusion: Five valuable antimony compounds and Amphotericin B can be used in the treatment of leishmenia. Nevertheless, allopurinol and ketoconazole, which are used orally, are safe and inexpensive treatment methods and we think that it may be another treatment option in our country