Comparison of Efficacy of Oral Azithromycin Versus Oral Chloroquine in the Treatment of Cutaneous Leishmaniasis

Background: Cutaneous leishmaniasis is a parasitic disease-causing significant morbidity, particularly in endemic regions. Effective and accessible treatments are crucial, especially in resource-limited settings. While antimonials remain the standard, oral chloroquine and azithromycin have emerged as potential alternatives, though their comparative efficacy remains understudied. Objective: To compare the efficacy of oral azithromycin and oral chloroquine in the treatment of cutaneous Leishmaniasis. Study Design: Randomized controlled trial. Duration and Place of Study: The study was conducted from December 2024 to February 2025 at the Dermatology Department of the Pakistan Institute of Medical Sciences (PIMS), Islamabad. Methodology: Sixty patients with confirmed CL were randomized into two groups: Group A received oral chloroquine (250 mg twice daily) and Group B received oral azithromycin (250 mg twice daily) for six weeks. Lesion characteristics, including size, induration and healing were assessed fortnightly. Efficacy was defined as complete lesion healing with or without scarring, confirmed by reduced lesion size and absence of amastigotes on rebiopsy. Results: The mean age of participants was 36.82 ± 10.54 years, with 63.3% males and 36.7% females. Lesions were predominantly on hands and arms (73.3% in Group A, 53.3% in Group B). Chloroquine demonstrated significantly higher efficacy (90%) compared to azithromycin (60%) (p=0.015). Conclusion: Our study confirms that oral chloroquine is highly effective for cutaneous leishmaniasis, outperforming azithromycin. Chloroquine showed consistent efficacy across age, gender and lesion locations, particularly for extremity lesions and shorter disease duration. Azithromycin had moderate overall efficacy but was significantly less effective in females and body lesions.