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The impact of multiple drug therapy on leprosy disabilities.

In an overview of controlled trials, it is shown that bactericidal drugs increase the short-term risk of Type I reactions, but prevent the long-term development of new impairments caused by bacterial proliferation. Clinical experience suggests that the clofazimine component of multiple drug therapy (MDT) has reduced the incidence of Type II reactions or erythema nodosum leprosum (ENL). The principal impact of MDT, compared with monotherapy, has been to reduce the duration of active disease, thus preventing the deterioration of disability scores. Reduction of population disability rates is mainly achieved by earlier detection and treatment. MDT has a number of indirect benefits such as improved compliance, decreased cost, and increased motivation and availability of leprosy workers. However, MDT must be supplemented by other measures to prevent and treat disabilities.