Topical Treatment of Recalcitrant Ulcerative Old World Leishmaniasis With WR 279,396

Inclusion Criteria: Parasitologically confirmed, primarily ulcerative, Old World CL, in a patient who had either failed pentavalent antimony treatment, or who was ineligible for pentavalent antimony therapy. * Military health care beneficiary 18 years of age or greater, unless active military in which case, 17 years is the minimum age * Proven parasitological diagnosis by culture, PCR or microscopy in at least one skin lesion * Lesions primarily ulcerative (i.e., not verrucous or nodular) * Written informed consent to participate in protocol * Negative pregnancy test within 72 hours of starting protocol * Agrees to take precautions not to become pregnant or father a child for at least two months after completion of treatment with WR 279,396 * Cutaneous leishmaniasis acquired in Southwest Central Asia/Middle East\* * Inadequate response to treatment with pentavalent antimony or medical condition that precludes the use of pentavalent antimony Exclusion Criteria: * Drug intolerance: history of known or suspected hypersensitivity or idiosyncratic reactions to aminoglycosides in the patient * any leishmanial lesion on mucosal surface * Presence of signs or symptoms of peripheral neuropathic myasthenia gravis, neuromuscular block * Routinely taking nephrotoxic or ototoxic medications * Disseminated disease defined as clinically significant subcutaneous nodules that are in the lymphatic drainage tract for the skin lesion with regional adenopathy \> 1 cm * Abnormal Romberg test a…