infectious diseases
Leprosy
Treatment of Leprosy
Long-term, multidrug regimens withdapsone,rifampin, and sometimesclofazimine Sometimes lifelong maintenance antibiotics Antibiotics can stop the progression of leprosy but do not reverse any nerve damage or deformity. Thus, early detection and treatment are vitally important. Because of antibiotic resistance, multidrug regimens are used. The drugs chosen depend on the type of leprosy; multibacillary leprosy requires more intensive regimens and a longer duration than paucibacillary leprosy does. Advice about diagnosis and treatment is available from the US Health Resources and Services Administration'sNational Hansen’s Disease (Leprosy) Program(or call 1-800-642-2477). Standard regimens recommended by the World Health Organization (WHO) differ somewhat from those used in the US (see the WHO's2018 guidelines for the diagnosis, treatment and prevention of leprosy). The standard WHO regimen includesdapsone,rifampin, andclofazimine. WHO provides these drugs free for all leprosy patients throughout the world. Adults takerifampin600 mg orally once/month andclofazimine300 mg orally once/month under a health care practitioner’s supervision anddapsone100 mg orally once/day plusclofazimine50 mg orally once/day without supervision. This regimen is continued for 12 months. In the US, the regimen isrifampin600 mg orally once/day,dapsone100 mg orally once/day, andclofazimine50 mg orally once/day for 24 months. In the standard WHO regimen, patients takerifampin600 mg orally once/month with supervision anddapsone100 mg orally once/day without supervision for 6 months. In the US, the regimen isrifampin600 mg orally once/day anddapsone100 mg orally once/day for 12 months. Dapsoneis relatively inexpensive and generally safe to use. Adverse effects include hemolysis and anemia (which are usually mild) and allergic dermatoses (which can be severe); rarely,dapsonesyndrome (exfoliative dermatitis, high fever, mononucleosis-like white blood cell differential) occurs. Rifampin,is primarily bactericidal forM. lepraeand is even more effective thandapsone. However, if given at the recommended US dosage of 600 mg orally once/day, it is too expensive for many poorer countries, but it is available free from the WHO. Adverse effects include hepatotoxicity, flu-like syndromes, and, rarely, thrombocytopenia and renal failure. Clofazimineis extremely safe. The main side effect is reversible skin pigmentation, but discoloration may take months to resolve.Clofaziminecan be obtained in the US only from the Department of Health and Human Services as an investigational new drug. To request further information or investigator status to be able to useclofazimine, clinicians can contact theNational Hansen's Disease (Leprosy) Programor call 1-800-642-2477. Patients with type 1 leprosy reactions (except minor skin inflammation) are givenprednisone40 to 60 mg orally once/day initially, followed by low maintenance doses (often as low as 10 to 15 mg once/day) for a few months. Minor skin inflammation should not be treated. First and second episodes of erythema nodosum leprosum may be treated, if mild, withaspirinor, if significant, with 1 week ofprednisone40 to 60 mg orally once/day plus antimicrobials. For recurrent cases,thalidomide100 to 300 mg orally once/day is the drug of choice (in the US, available through theNational Hansen's Disease (Leprosy) Program). However, because of its teratogenicity,thalidomideshould not be given to women who may become pregnant. Adverse effects are mild constipation, mild leukopenia, and sedation. 