Medications for Leprosy Treatment
The standard treatment for leprosy consists of multidrug therapy (MDT) with rifampin, dapsone, and clofazimine as the core medications, with treatment duration varying from 6-12 months depending on disease classification. 1
Classification and Treatment Regimens
Paucibacillary Leprosy (PB)
- Treatment consists of rifampin and dapsone for at least 6 months 2
- Rifampin: Monthly supervised dose 3
- Dapsone: Daily self-administered dose (typically 100 mg daily for adults) 4
Multibacillary Leprosy (MB)
- Treatment consists of rifampin, dapsone, and clofazimine for at least 12 months 3
- Rifampin: Monthly supervised dose (600 mg) 4
- Dapsone: Daily self-administered dose (100 mg) 4
- Clofazimine: Monthly supervised dose plus daily self-administered dose (50-100 mg) 5
Core Medications
Dapsone
- Dosage: 100 mg daily for adults in multidrug regimens 4
- Pediatric dosing: 1-2 mg/kg/day 4
- Mechanism: Inhibits folate synthesis in bacteria 4
- Adverse effects: Hemolytic anemia (especially in G6PD deficiency), methemoglobinemia, peripheral neuropathy, and hypersensitivity reactions 5
- Monitoring: Complete blood count, liver function tests 5
Rifampin (Rifampicin)
- Dosage: 600 mg monthly under supervision 3
- Mechanism: Inhibits bacterial RNA polymerase 3
- Adverse effects: Hepatotoxicity, flu-like syndrome, orange discoloration of body fluids 3
- Drug interactions: Significant interactions with many medications due to cytochrome P450 induction 3
Clofazimine
- Dosage: 50-100 mg daily for multibacillary leprosy 5
- Mechanism: Anti-inflammatory and antimycobacterial properties 5
- Adverse effects: Skin pigmentation (75-100% of patients), ichthyosis (8-20%), gastrointestinal intolerance (40-50%), and QT interval prolongation 5
- Special considerations: Comes in 50 and 100 mg gelcaps that cannot be split 5
Alternative Regimens
RMM Regimen (Monthly Rifampin, Moxifloxacin, and Minocycline)
- Emerging alternative with improved tolerability profile 6
- Advantages: No skin hyperpigmentation, better adherence, and fewer side effects 6
- Duration: 12-24 months 6
- Particularly useful when clofazimine or dapsone cannot be tolerated 6
Other Second-line Agents
- Ofloxacin: Used in combination regimens for paucibacillary leprosy 3
- Minocycline: Alternative in combination therapy 6
- Moxifloxacin: Component of newer regimens 6
- Ethionamide: Can be used as a third anti-leprosy drug (250-500 mg daily) 4
Special Populations
Children
- Dapsone: 1-2 mg/kg/day 4
- Clofazimine: 1-2 mg/kg/day (maximum 100 mg) 5
- Rifampin: Adjusted based on weight 4
- Safety profile in children: Clofazimine has been well-tolerated in pediatric leprosy trials 5
Pregnant Women
- Treatment should be continued during pregnancy as benefits outweigh risks 5
- Close monitoring required 5
Management of Leprosy Reactions
- Type 1 (Reversal) Reactions: Treated with corticosteroids 2
- Type 2 (Erythema Nodosum Leprosum): Treated with thalidomide or corticosteroids 3
- Continuation of MDT during reactions is essential 2
Monitoring and Follow-up
- Clinical monitoring for treatment response: Lesion flattening should occur by 4-6 weeks after treatment initiation 5
- Monitoring for drug toxicity: Regular assessment of liver function, complete blood count 5
- Post-treatment surveillance: Monitor for 6-12 months after completing therapy for signs of relapse 5
- QT interval monitoring with ECG when using clofazimine, especially when combined with other QT-prolonging medications 5
Emerging Approaches
- Single-dose therapy for paucibacillary leprosy: Combination of rifampin, ofloxacin, and minocycline 3
- Monthly administered regimens to improve adherence 6
- Shorter treatment durations (reduced from 24 to 12 months in recent years) 3
Early diagnosis and prompt initiation of appropriate multidrug therapy remain the cornerstones of effective leprosy management to prevent complications and disabilities 1.