Paromomycin

An orally administered aminoglycoside antibiotic from Streptomyces rimosus forma paromycinus that is active against Gram-negative and many Gram-positive bacteria as well as some protozoa and cestodes. It is no longer used as an antibiotic, but was approved in India in 2007 as an effective, well-tolerated and affordable treatment for visceral leishmaniasis (VL) at a dose of 11 mg/kg (base) for 21 days.

Paromomycin in combination with sodium stibogluconate has been shown to be effective in African and Indian VL and improves survival in African visceral leishmaniasis (VL). To prevent the emergence of drug-resistant leishmaniasis in areas with anthroponotic transmission (India and Africa), paromomycin should be used as part of combination therapy for VL (Davidson RN et al. 2009).

Systemic: 25-30 mg/kg bw/day p.o. in 3 ED over 5-10 days.

Topical: Apply 10-20% in ointments or creams 1-2 times/day under occlusion to the affected skin areas.

Remember! In ointment form effective against cutaneous leishmaniasis.

1. Davidson RN et al (2009) Paromomycin. Trans R Soc Trop Med Hyg 103:653-660.

2. Fernandez-Flores A et al. (2015) Morphological and immunohistochemical clues for the diagnosis of cutaneous leishmaniasis and the interpretation of CD1a status. J Am Acad Dermatol doi: 10.1016/j.jaad.2015.09.038
3. Fischer T et al. (2024)Treatment of mucocutaneous leishmaniasis- a systematic review. JDDG 22:763-774
4. Handler MZ et al. (2015) Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management.J Am Acad Dermatol. 2015 Dec;73(6):911-26; 927-8.