The Efficacy of Topical Paromomycin-Gentamicin versus Topical Paromomycin Alone in The Treatment of Cutaneous Leishmaniasis: A meta-analysis of randomized controlled trials.

Cutaneous leishmaniasis (CL) is the most common protozoal skin infection worldwide. Multiple treatments for CL have been developed to address issues related to resistance, availability, and safety. Topical treatments have shown promise by reducing unnecessary systemic exposure and providing a viable local therapeutic option. A systematic review and meta-analysis were conducted of all literature published before 28 February 2025 through PubMed/MEDLINE, the Cochrane Library, and EBSCO, comparing topical paromomycin-gentamicin (PG) with topical paromomycin alone (PR). Two studies involving a total of 774 patients were included. Relative risks (RRs) from both studies were pooled using a fixed-effect meta-analysis. The meta-analysis showed no significant difference in the final clinical cure of the index lesion between PG and PR (RR = 1.030; 95% confidence interval [CI]: 0.950-1.117), nor in the rate of cure of all lesions (RR = 0.987; 95% CI: 0.909-1.072). No serious adverse events were reported. When treating CL topically, the addition of gentamicin to paromomycin does not confer additional benefit.