Antimicrobial adjuvants to revert the Imbalance of skin Microbiota for improved outcomes of Cutaneous Leishmaniasis treatment in Ethiopia

Treatment of cutaneous leishmaniasis (CL) in Ethiopia is only provided in specialized treatment centers and has high failure rates, leaving many patients untreated and resulting in a high sociopsychological impact. Recent studies outside Ethiopia show that disturbance of the skin microbiome, called dysbiosis, is associated with more severe CL lesions and poor treatment responses. We hypothesize that reversing this dysbiosis can enhance the healing process and
accordingly improve outcomes. The AIM-CL project will first determine the extent of dysbiosis in CL lesions, and identify the opportunistic bacteria and their antibiotic resistance, to guide the selection of an appropriate antimicrobial agent. Next, we will assess the effectiveness of the selected topical antimicrobial as an adjuvant to the standard of care for CL lesions in a randomized controlled clinical trial, in a hospital and primary healthcare setting. By studying the
changes in the microbiome composition during treatment we will gain insight in the effect of the antibiotics. Last, an ethnographic study will examine the acceptability and feasibility of treatment in the primary healthcare unit. The AIM-CL project is an interdisciplinary project that combines medical anthropology with clinical and biomedical sciences to gain novel insights in the role of the skin microbiome in CL treatment and can have a large societal impact on care
provision in Ethiopia and beyond.