COMPARATIVE EFFICACY OF INTRAMUSCULAR MEGLUMINE ANTIMONIATE AND MILTEFOSINE IN THE MANAGEMENT OF CUTANEOUS LEISHMANIASIS

Abstract

Background: Cutaneous leishmaniasis is a frequent neglected parasitic skin disease in endemic areas, and can lead to chronic ulcers, disfigurement, scarring and psychosocial impacts. The standard injectable drug is meglumine antimoniate and the oral drug is miltefosine which is easier to administer. Local comparative data on their clinical effectiveness, however, are still very scarce.

Objective: To compare the efficacy of intramuscular meglumine antimoniate and oral miltefosine in the management of cutaneous leishmaniasis.

Methods: This non-randomized controlled trial was carried out in the Department of Dermatology, MTI Khyber Teaching Hospital, Peshawar from October 2025 to April 2026. The total number of cutaneous Leishmaniasis patients were 126 and they were sampled consecutively in non-probability sampling and divided into two equal groups. Group A was given intramuscular meglumine antimoniate and Group B was administered oral miltefosine for 4 weeks. The effectiveness of the treatment was determined at the end of the treatment and was defined as the clinical improvement of 90% or more, including the flattening of the lesion, re-epithelialization of the ulceration and disappearance of the induration. The analysis of data was done with SPSS version 24.

Results: Effective treatment response was observed in 48 (76.2%) patients in the meglumine antimoniate group and 36 (57.1%) patients in the miltefosine group. The difference between the two groups was statistically significant (p=0.023). Injection site pain was more common with meglumine antimoniate, whereas nausea and vomiting were more frequent with miltefosine.

Conclusion: Intramuscular meglumine antimoniate showed better short-term efficacy than oral miltefosine in patients with cutaneous leishmaniasis. However, treatment selection should consider efficacy, adverse effects, route of administration, and patient preference.