Leprosy treatment -chemotherapy

Leprosy is classified into paucibacillary or multibacillary leprosy based on the number of patches.

MULTIBACILLARY (MB) LEPROSY

6 or more skin patches or more than one nerveinvolvementTreatment: 12 MB blister packs.

PAUCIBACILLARY (PB) LEPROSY

1-5 skin patches or onlyone nerve involvementTreatment: 6 PB blister packs

The 1st line antileprotic drugs : Rifampicin, Dapson, Clofazimine.

Rifampicin: Potent bactericidal. Inhibits DNA dependent RNA

polymerase. Well absorbed orally. Hepatotoxic.

Dapsone:(diamino-diphenyl sulfone) : Blocking folic acid synthesis Weakly bactericidal. Well absorbed orally, long

half life. Hemolytic anaemia,methemoglobinemia, DDS syndrome (LN, hepatosplenomegaly, fever and hepatites)

Clofazimine : Dye, weakly bactercidal action, anti-inflammatory action. Skin discoloration, icthyosis on shins and forearms. GIT upset

WHO Multidrug therapy (MDT) :WHO Multidrug therapy (MDT) Since 1995, WHO has supplied MDT free of cost to leprosy patients in all endemic countries.

Each blister pack contains treatment for 4 weeks PB adult treatment: Once a month: Day 1 2 capsules of rifampicin (300 mg X 2) 1 tablet of dapsone (100 mg)

Once a day: Days 2-281 tablet of dapsone (100 mg)

Full course: 6 blister packs.

PB adult blister pack

MB adult treatment:Once a month: Day 1- 2 capsules of rifampicin (300 mg X 2)- 3 capsules of clofazimine (100mg X 3)- 1 tablet of dapsone (100 mg

Once a day: Days 2-28- 1 capsule of clofazimine (50 mg)- 1 tablet of dapsone (100 mg)

Full course: 12 blister packs.

MB adult blister pack

PB child treatment (10-14 years):Once a month: Day 1- 2 capsules of rifampicin- (300 mg + 150 mg)- 1 tablet of dapsone (50 mg)

Once a day: Days 2-28- 1 tablet of dapsone (50 mg)

Full course: 6 blister packs

MB child treatment (10-14 years):Once a month: Day 1- 2 capsules of rifampicin- (300 mg + 150 mg)- 3 capsules of clofazimine ( 50 mg X 3)- 1 tablet of dapsone (50 mg)

Once a day: Days 2-28- 1 capsule of clofazimine every other day- (50 mg)- 1 tablet of dapsone (50 mg)

Full course: 12 blister packs

Explain how touse the BlisterCalendar Pack(BCP). It is crucialto explain whichtablets are to betaken monthlyand which daily

SafetyMDT is very safe and effective in curing leprosy.MDT is safe during pregnancy.MDT is safe for patients being treated for tuberculosis

(TB)as well as those who are HIV-positive.Rifampicin is common to the treatment of leprosy and

TBand must be given in doses required for TB.

Over 10 million people have been cured of leprosy with MDT

Leprosy reactions : Type 1 or reversal reactions Lesions caused by a change in the

immunologic defence of the patient 30% in borderline leprosy. Erythema, swelling, and tenderness of skin

lesions and tenderness of peripheral nerves

Type 2 reactions Erythema nodosum leprosum. 20% of LL and 10%of BL patients Widespread erythema nodosum,neuritis, iritis,

arthritis, orchitis, lymphoadenopathy and renal disease.

Severe ENL reactions include - Numerous ENL nodules with high fever- - ENL nodules and neuritis- Ulcerating and pustular ENL- - Recurrent episodes of ENL – - Involvement of other organs (e.g. eyes, testes, lymph

nodes and joints)

TREATMENT OF SEVERE ENL:Maximum dose of prednisolone is 1 mg per kg of body

weight. 40 mg daily for weeks 1 and 2, 30 mg daily for weeks 3 and 4, 20 mg daily for weeks 5 and 6, 15 mg daily for weeks 7 and 8, 10 mg daily for weeks 9 and 10, 5 mg daily for weeks 11 and 12.

Management with Clofazimine and Corticosteroids

Use standard course of prednisolone in dosage per day not exceeding 1 mg per Kg body weight.

Start clofazimine 100 mg three times a day for maximum of 12 weeks.

Complete the standard course of prednisolone. Continue clofazimine as below.

Taper the dose of clofazimine to 100 mg twice a day for 12 weeks and then 100 mg once a day for 12-24 weeks.

Leprosy can be easily cured!