6.Chemotherapy And Dis Ability Preventation

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6.Chemotherapy And Dis Ability Preventation

  1. 1. Leprosy treatment -chemotherapy
  2. 2. <ul><li>Leprosy is classified into paucibacillary or multibacillary leprosy based on the number of patches. </li></ul><ul><li>MULTIBACILLARY (MB) LEPROSY </li></ul><ul><li>6 or more skin patches or more than one nerve </li></ul><ul><li>involvement </li></ul><ul><li>Treatment: 12 MB blister packs. </li></ul><ul><li>PAUCIBACILLARY (PB) LEPROSY </li></ul><ul><li>1-5 skin patches or only </li></ul><ul><li>one nerve involvement </li></ul><ul><li>Treatment: 6 PB blister packs </li></ul>
  3. 3. <ul><li>The 1st line antileprotic drugs : Rifampicin, Dapson, Clofazimine. Rifampicin: </li></ul><ul><li>Potent bactericidal. Inhibits DNA dependent RNA polymerase. </li></ul><ul><li>Well absorbed orally. </li></ul><ul><li>Hepatotoxic. </li></ul>
  4. 4. <ul><li>Dapsone:(diamino-diphenyl sulfone) : </li></ul><ul><li>Blocking folic acid synthesis </li></ul><ul><li>Weakly bactericidal. Well absorbed orally, long half life. Hemolytic anaemia,methemoglobinemia, DDS syndrome (LN, hepatosplenomegaly, fever and hepatites) </li></ul><ul><li>Clofazimine : Dye, weakly bactercidal action, anti-inflammatory action. Skin discoloration, icthyosis on shins and forearms. GIT upset </li></ul>
  5. 5. <ul><li>WHO Multidrug therapy (MDT) :WHO Multidrug therapy (MDT) Since 1995, WHO has supplied MDT free of cost to leprosy patients in all endemic countries. </li></ul>
  6. 6. <ul><li>Each blister pack contains treatment for 4 weeks </li></ul><ul><li>PB adult treatment: </li></ul><ul><li>Once a month: Day 1 </li></ul><ul><li>2 capsules of rifampicin (300 mg X 2) </li></ul><ul><li>1 tablet of dapsone (100 mg) </li></ul><ul><li>Once a day: Days 2-28 </li></ul><ul><li>1 tablet of dapsone (100 mg) </li></ul><ul><li>Full course : 6 blister packs. </li></ul>
  7. 7. <ul><li>PB adult blister pack </li></ul>
  8. 8. <ul><li>MB adult treatment: </li></ul><ul><li>Once a month: Day 1 </li></ul><ul><li>- 2 capsules of rifampicin (300 mg X 2) </li></ul><ul><li>- 3 capsules of clofazimine (100mg X 3) </li></ul><ul><li>- 1 tablet of dapsone (100 mg </li></ul><ul><li>Once a day: Days 2-28 </li></ul><ul><li>- 1 capsule of clofazimine (50 mg) </li></ul><ul><li>- 1 tablet of dapsone (100 mg) </li></ul><ul><li>Full course : 12 blister packs. </li></ul>
  9. 9. <ul><li>MB adult blister pack </li></ul>
  10. 10. <ul><li>PB child treatment (10-14 years): </li></ul><ul><li>Once a month: Day 1 </li></ul><ul><li>- 2 capsules of rifampicin </li></ul><ul><li>- (300 mg + 150 mg) </li></ul><ul><li>- 1 tablet of dapsone (50 mg) </li></ul><ul><li>Once a day: Days 2-28 </li></ul><ul><li>- 1 tablet of dapsone (50 mg) </li></ul><ul><li>Full course : 6 blister packs </li></ul>
  11. 11. <ul><li>MB child treatment (10-14 years): </li></ul><ul><li>Once a month: Day 1 </li></ul><ul><li>- 2 capsules of rifampicin </li></ul><ul><li>- (300 mg + 150 mg) </li></ul><ul><li>- 3 capsules of clofazimine ( 50 mg X 3) </li></ul><ul><li>- 1 tablet of dapsone (50 mg) </li></ul><ul><li>Once a day: Days 2-28 </li></ul><ul><li>- 1 capsule of clofazimine every other day </li></ul><ul><li>- (50 mg) </li></ul><ul><li>- 1 tablet of dapsone (50 mg) </li></ul><ul><li>Full course : 12 blister packs </li></ul>
  12. 12. <ul><li>Explain how to </li></ul><ul><li>use the Blister </li></ul><ul><li>Calendar Pack </li></ul><ul><li>(BCP). It is crucial </li></ul><ul><li>to explain which </li></ul><ul><li>tablets are to be </li></ul><ul><li>taken monthly </li></ul><ul><li>and which daily </li></ul>
  13. 13. <ul><li>Safety </li></ul><ul><li>MDT is very safe and effective in curing leprosy. </li></ul><ul><li>MDT is safe during pregnancy. </li></ul><ul><li>MDT is safe for patients being treated for tuberculosis (TB) </li></ul><ul><li>as well as those who are HIV-positive. </li></ul><ul><li>Rifampicin is common to the treatment of leprosy and TB </li></ul><ul><li>and must be given in doses required for TB. </li></ul>
  14. 14. <ul><li>Over 10 million people have been cured of leprosy with MDT </li></ul>
  15. 15. <ul><li>Leprosy reactions : </li></ul><ul><li>Type 1 or reversal reactions </li></ul><ul><li>Lesions caused by a change in the immunologic defence of the patient </li></ul><ul><li>30% in borderline leprosy. </li></ul><ul><li>Erythema, swelling, and tenderness of skin lesions and tenderness of peripheral nerves </li></ul><ul><li>Type 2 reactions </li></ul><ul><li>Erythema nodosum leprosum. </li></ul><ul><li>20% of LL and 10%of BL patients </li></ul><ul><li>Widespread erythema nodosum,neuritis, iritis, arthritis, orchitis, lymphoadenopathy and renal disease. </li></ul>
  16. 16. <ul><li>Severe ENL reactions include </li></ul><ul><li>Numerous ENL nodules with high fever- </li></ul><ul><li>ENL nodules and neuritis </li></ul><ul><li>Ulcerating and pustular ENL- </li></ul><ul><li>Recurrent episodes of ENL – </li></ul><ul><li>Involvement of other organs (e.g. eyes, testes, lymph nodes and joints) </li></ul>
  17. 17. <ul><li>TREATMENT OF SEVERE ENL: </li></ul><ul><li>Maximum dose of prednisolone is 1 mg per kg of body weight. </li></ul><ul><li>40 mg daily for weeks 1 and 2, </li></ul><ul><li>30 mg daily for weeks 3 and 4, </li></ul><ul><li>20 mg daily for weeks 5 and 6, </li></ul><ul><li>15 mg daily for weeks 7 and 8, </li></ul><ul><li>10 mg daily for weeks 9 and 10, </li></ul><ul><li>5 mg daily for weeks 11 and 12. </li></ul>
  18. 18. <ul><li>Management with Clofazimine and Corticosteroids </li></ul><ul><li>Use standard course of prednisolone in dosage per day not exceeding 1 mg per Kg body weight. </li></ul><ul><li>Start clofazimine 100 mg three times a day for maximum of 12 weeks. </li></ul><ul><li>Complete the standard course of prednisolone. Continue clofazimine as below. </li></ul><ul><li>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. </li></ul>
  19. 19. <ul><li>Leprosy can be easily cured! </li></ul>

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