The document discusses the treatment of leprosy, known as Multi-Drug Therapy (MDT). MDT involves taking a combination of two or more oral anti-leprosy drugs daily and monthly under direct observation. The standard regimens depend on whether a patient has paucibacillary or multibacillary leprosy and can cause minor side effects. Adherence to the full treatment course is important to cure the disease and prevent further nerve damage and disability. Health education of patients is also a key part of effective leprosy management.

1. TREATMENT
OF
LEPROSY
Susana V. Caseria, MD

2. What is MDT?
• Multi-Drug Therapy (MDT) is the
accepted standard treatment for
leprosy.
• It is a combination of two (2) or
more anti-leprosy drugs:
• Dapsone • Ofloxacin
• Rifampicin • Minocycline
• Clofazimine

3. PB Blister Pack PB Blister Pack
(Adult) (Child)

4. MB Blister Pack MB Blister Pack
(Adult) (Child)

5. SIDE EFFECTS:
Rifampicin:
• May cause slightly reddish discoloration
of urine within a few hours after intake.
• Patient may experience body malaise,
joint and muscle pains.

6. SIDE EFFECTS:
Clofazimine:
• Gastric irritation.
• Skin discoloration
(disappears a few months
after stopping treatment).

7. SIDE EFFECTS:
Clofazimine:
• Gastric irritation.
• Skin discoloration
(disappears a few months
after stopping treatment).
• Dryness of skin.

8. SIDE EFFECTS:
Dapsone:
• Side effects are rare.
• Some patients may develop allergic
reactions causing itchy skin rashes and
exfoliative dermatitis.
• Patients who are allergic to any of the
sulfa drugs should not be given Dapsone.

9. SIDE EFFECTS
DAPSONE
 Hemolytic anemia – most common
G6PD deficiency
 Psychosis
 DDS Syndrome - 1st 6 weeks
 Fever
 Exfoliative dermatitis
 Hepatitis
 Cholestatic jaundice
 splenomegaly
 lymphadenopathy

10. FLUOROQUINOLONES
 Inhibit DNA gyrase
 Basically vs. gram (-) bacteria
 In vivo & in vitro activity of Ofloxacin against M.leprae (Saito,et
al, 1986)
 3 commercial derivatives tested in mouse footpad system
(Grosset, et al)
-Ciprofloxacin was inactive
-Pefloxacin had bactericidal activity at
150mg/KBNW/day
-Ofloxacin at 50 mg/KBW/day had the same effect
-Ofloxacin at 1500 mg/KBW/day had profound killing
activity

11. SIDE EFFECTS:
Ofloxacin:
• Well absorbed, reaches peak serum
concentration after 2 hours.
• May cause nausea, diarrhea, headache,
dizziness and insomnia.

12. MINOCYCLINE
 Activity of minocycline in M. leprae infected
mice ( Dr. Gelber, 1987)
 Clinical trial of minocycline in lepromatous
leprosy (Dr. Gelber et al)
- 8 untreated lepromatous pts
- 100 OD X 3 mos.
- all were negative after 3 months
- clearance :faster than dapsone &,
clofazimine, slower than rifampicin &
similar to pefloxacin, ofloxacin

13. SIDE EFFECTS:
Minocycline:
• Has significant bactericidal activity
against M. leprae.
• May cause discoloration of teeth in
children, occasional pigmentation of the
skin, gastro-intestinal disturbance and
dizziness.

14. CONTRA-INDICATIONS TO MDT:
• Cases with severe liver and kidney
disease.
• Severe hypersensitivity to any of the
MDT drugs.
• Severe anemia.
• Ofloxacin & Minocycline are not
recommended for use in pregnant women
and children below five (5) years old.

15. TREATMENT: MULTIBACILLARY
LEPROSY
 TRIPLE DRUG THERAPY
1. Dapsone 100 mg OD
2. Clofazimine 50 mg OD
AND Supervised
3. Rifampicin 600 mg monthly
4. Clofazimine 300 mg monthly

16. TREATMENT: PAUCIBACILLARY
LEPROSY
 DUAL DRUG THERAPY
1. Dapsone 100 mg OD
AND Supervised
2. Rifampicin 600 mg monthly

17. DURATION OF TREATMENT
 MULTIBACILLARY: 12 months
 PAUCIBACILLARY: 6 months

18. Adult Multibacillary Regimen:
(For MB leprosy patients above 15 years old)
Day 1 Rifampicin – 600mg
(Monthly Dose) Clofazimine – 300mg
Dapsone – 100mg
Day 2-28 Clofazimine – 50mg
(Daily Doses) Dapsone – 100mg
Duration of Twelve (12) blister
Treatment packs to be taken
monthly within a
maximum of 18
months

19. Pedia Multibacillary Regimen:
(For MB leprosy patients 10-15 years old)
Day 1 Rifampicin – 450mg
(Monthly Dose) Clofazimine – 150mg
Dapsone – 50mg
Day 2-28 Clofazimine – 50mg
(Daily Doses) (every other day)
Dapsone – 50mg
Duration of Twelve (12) blister
Treatment packs to be taken
monthly within a
maximum of 18
months

20. Adult Paucibacillary Regimen:
(For PB leprosy patients above 15 years old)
Day 1 Rifampicin – 600mg
(Monthly Dose) Dapsone – 100mg
Day 2-28 Dapsone – 100mg
(Daily Doses)
Duration of Six (6) blister packs
Treatment to be taken monthly
within a maximum
of nine (9) months

21. Pedia Paucibacillary Regimen:
(For PB leprosy patients 10-15 years old)
Day 1 Rifampicin – 450mg
(Monthly Dose) Dapsone – 50mg
Day 2-28 Dapsone – 50mg
(Daily Doses)
Duration of Six (6) blister packs
Treatment to be taken monthly
within a maximum
of nine (9) months

22. For children below ten
(10) years old, the dose
may be adjusted.
i

23. Single-Lesion Paucibacillary Regimen:
(ROM for SLPB leprosy patients)
Adult (2 blister packs)
Rifampicin – 600mg (2 x 300mg)
Ofloxacin – 400mg (2 x 200mg)
Minocycline – 100mg (2 x 50mg)
Child (1 blister pack)
Rifampicin – 300mg
Ofloxacin – 200mg
Minocycline – 50mg

24. TREATMENT
 Leprosy can now be treated at home
 Health Education is an integral part of
treatment
 To be effective, treatment should be
adequate, regular and continuous

25. TREAT CORRECTLY THEN STOP
TREATMENT
 Always treat with full doses
 Never reduce the dose
 If complications arise, may use a different
drug

26. THE MAJOR PROBLEM IN
LEPROSY CONTROL
IS
PATIENT COMPLIANCE
Use every means to gain patient’s
cooperation, so that they will take
treatment as long as necessary

29. PATIENT EDUCATION:
The success of MDT treatment is the
joint responsibility of the doctor and the
leprosy patient.
Please educate your patient about the
importance of treatment compliance and give
corresponding instructions or advice.

31. Important Messages
Health Advice / Instruction
About MDT
1. Leprosy is curable with Advise the patient to
MDT if taken regularly take his monthly and daily
and continuously, and if doses of MDT drugs
the prescribed number regularly, continuously
of blister packs are and adequately to make
consumed within the sure that he gets cured of
prescribed period of 12- the disease.
18 months for MB and
6-9 months for PB.

32. Important Messages
Health Advice / Instruction
About MDT
2. A leprosy patient Explain to the patient
becomes non-infectious and his family that he
after starting MDT. becomes non-infectious
one month after taking the
initial dose of MDT drugs.

33. Important Messages
Health Advice / Instruction
About MDT
3. During the course of Teach the patient to
treatment, leprosy recognize the early signs
reactions may occur. of reaction and advise him
to report immediately for
appropriate intervention in
case it occurs.
Advise him to
continue MDT intake
even during reactions.

34. Important Messages
Health Advice / Instruction
About MDT
4. Impairments of the eyes, Advise the patient to
hands and feet are take care of his anesthetic
preventable. eyes, hands and feet by
using protective devices
such as sunglasses, hats,
gloves and shoes.

35. Important Messages
Health Advice / Instruction
About MDT
5. MDT is available FREE Advise the patient to
of charge in Rural collect his MDT blister
Health Units. packs at the RHU until all
the prescribed number of
blister packs are taken.

36. TREATMENT COMPLETION:
Treatment is completed when:
• A PB patient has taken 6 MDT blister
packs within 6-9 months.
• An MB patient has taken 12 MDT blister
packs within 12-18 months.
• An SLPB patient has taken the single
dose of ROM.

37. Remember: A leprosy
case who has completed a
full course of treatment
i
should no longer be regarded as a
leprosy patient.

38. TREATMENT COMPLETION:
Upon completion of treatment:
• Remind the patient about the early signs
of a leprosy reaction.
• Teach him the early signs of a relapse.
• Encourage him to continue self-care of
the eyes, hands and feet to prevent
injuries that may lead to deformities.

39. DEFAULTERS:
A defaulter is a patient who has started
treatment but who has not collected his
MDT drugs for six (6) consecutive months.
It is, however, important that adequate
efforts are made to trace these patients and
persuade them to return for assessment and
re-treatment.

40. A defaulter who returns
for re-treatment should
be given a new course of
i
MDT.

41. PATIENTS WITH SPECIAL NEEDS:
Accompanied MDT:
Sometimes, patients have to interrupt
their treatment for one reason or another:
• Poor access to the health service;
• No one is at the Health Center when they
come to collect their blister packs;
• Nature of work (e.g. fisherman);
• Insurgency.

42. PATIENTS WITH SPECIAL NEEDS:
Accompanied MDT:
With Accompanied MDT, they are given
the first dose at the Health Center, and
allowed to bring home the remaining blister
packs to complete the treatment at home.

43. PATIENTS WITH SPECIAL NEEDS:
Accompanied MDT:
The treatment procedure is taught to the
patient and, if possible, a home companion.
They are then instructed to report to the
Health Center if problems occur or when
treatment is completed.

44. PATIENTS WITH SPECIAL NEEDS:
Pregnancy:
The standard regimens are considered
safe for both the mother and child.
If a woman becomes pregnant during the
course of treatment, continue MDT.
However, if a woman is 1-3 months
pregnant, wait until the 2nd trimester before
starting MDT.

45. PATIENTS WITH SPECIAL NEEDS:
Tuberculosis:
Patients suffering from both leprosy and
tuberculosis require appropriate anti-TB
therapy in addition to MDT.

46. PATIENTS WITH SPECIAL NEEDS:
Tuberculosis:
Since Rifampicin doses for TB are larger
than those in MDT, remove the Rifampicin
capsules from the MDT blister packs for the
duration of the TB therapy.
Give the Clofazimine and Dapsone
together with the TB regimen.
When the TB treatment is completed,
resume the prescribed MDT regimen.

47. PATIENTS WITH SPECIAL NEEDS:
HIV Infection:
The management of a leprosy patient
infected with HIV is the same as with any
other leprosy patient.
Information available so far indicate that
their response to MDT is the same.
The management, including treatment of
reactions, does not require modifications.

48. PATIENTS WITH SPECIAL NEEDS:
Relapse:
Relapse is the recurrence of leprosy after
the successful completion of treatment.
It is characterized by the occurrence of
new lesions.

49. PATIENTS WITH SPECIAL NEEDS:
Relapse:
The probability of relapse after MDT is
very rare.
It is often confused with reactions which
can also occur after cure.
A Morphological Index is highly
recommended when there is suspicion of a
relapse.

50. OTHER POSSIBLE DRUGS
 CLARITHROMYCIN
 BETA LACTAM ANTIBIOTIC
 RIFAMYCIN DERIVATIVES
 STREPTOMYCIN
 FUSIDIC ACID

51. CLARITHROMYCIN
 Completely prevented the growth of M.
leprae resistant & susceptible to dapsone
& rifampicin (Walker,et al)
 No antagonistic drug interaction with
rifampicin
 Less active than minocycline (Ji, et al)
 Minocycline and clarithromycin have
additive effects

52. OTHER DRUGS
 Beta Lactam antibiotic
-interfere with cell wall synthwesis
-must be administered by injection
 Rifamycin derivatives
-Rifabutin, Rifapertine, and R-76-1
-No difference in activity with
Rifampicin
-No report to support activity vs.
rifampicin-resistant strains

53. OTHER DRUGS
STREPTOMYCIN
-Bacteriostatic
-Given by injection
FUSIDIC ACID
-Highly active against intra/extracellular
M. leprae (Franzblau, et al)

54. Thank You!