What is the treatment for leprosy?

Treatment of Leprosy

The standard treatment for leprosy consists of multidrug therapy (MDT) with dapsone, rifampicin, and clofazimine for 12 months for multibacillary leprosy and 6 months for paucibacillary leprosy. 1, 2

Classification and Treatment Regimens

Paucibacillary Leprosy (PB)

• Characterized by few skin lesions with no detectable bacilli on skin smears 2
• Treatment regimen: 6 months of MDT consisting of:
  • Rifampicin: 600 mg once monthly (supervised)
  • Dapsone: 100 mg daily (self-administered) 1, 3

Multibacillary Leprosy (MB)

• Characterized by multiple skin lesions, nodules, plaques, thickened dermis/nerves, or positive skin smears 2
• Treatment regimen: 12 months of MDT consisting of:
  • Rifampicin: 600 mg once monthly (supervised)
  • Clofazimine: 300 mg once monthly (supervised) and 50 mg daily (self-administered)
  • Dapsone: 100 mg daily (self-administered) 1, 3

Medication Details

Dapsone

• Mechanism: Inhibits bacterial dihydrofolic acid synthesis 4
• Dosage: 100 mg daily for adults 4
• Monitoring: Regular complete blood count and liver function tests due to risk of hemolytic anemia and methemoglobinemia 1
• Contraindications: G6PD deficiency requires screening before treatment 5
• Side effects: Hemolysis, methemoglobinemia, nausea/vomiting 5, 4

Clofazimine

• Mechanism: Anti-inflammatory and antimycobacterial properties 1
• Dosage: 50-100 mg daily for multibacillary leprosy 1
• Available as 50 mg and 100 mg gelcaps that cannot be split 1
• Side effects: Skin pigmentation, ichthyosis, gastrointestinal intolerance, QT interval prolongation 1
• Requires ECG monitoring when combined with other QT-prolonging medications 1

Rifampicin (Rifampin)

• Most bactericidal anti-leprosy drug 6
• Dosage: 600 mg once monthly (supervised administration) 3
• Side effects: Hepatotoxicity, drug interactions due to CYP450 induction 6

Special Populations

Pediatric Patients

• Dosages adjusted by weight:
  • Clofazimine: 1-2 mg/kg/day (maximum 100 mg) 1
  • Dapsone: Adjust based on weight 1

Pregnant Women

• Treatment should be continued during pregnancy as benefits outweigh risks 1
• Close monitoring required 1

Alternative Regimens

Single Lesion Paucibacillary Leprosy

• Single-dose ROM therapy (Rifampicin 600 mg + Ofloxacin 400 mg + Minocycline 100 mg) has been recommended by WHO for patients with single-lesion paucibacillary leprosy 7

Drug-Resistant Cases

• Emerging resistant strains require alternative regimens 2, 8
• Newer drugs with demonstrated efficacy include:
  • Fluoroquinolones (ofloxacin, moxifloxacin)
  • Minocycline
  • Clarithromycin 7

Monitoring and Follow-up

• Clinical response: Lesion flattening expected by 4-6 weeks after treatment initiation 1
• Regular monitoring for drug toxicity, including liver function and complete blood count 1
• Post-treatment surveillance to monitor for signs of relapse 1

Management of Reactional States

Type 1 (Reversal) Reaction

• Occurs in borderline or tuberculoid leprosy, often after starting chemotherapy 4
• Characterized by swelling of existing skin and nerve lesions 4
• Management:
  • Continue anti-leprosy treatment
  • Steroids for severe cases or if neuritis is present
  • Analgesics
  • Surgical decompression of swollen nerve trunks if needed 4

Type 2 Reaction (Erythema Nodosum Leprosum/ENL)

• Occurs mainly in lepromatous patients (approximately 50% in first year) 4
• Characterized by fever, tender erythematous skin nodules, malaise, neuritis, and other systemic symptoms 4
• Management:
  • Continue anti-leprosy treatment
  • Analgesics and steroids to suppress the reaction
  • Hospitalization if severe 4

Key Points for Success

• Early diagnosis and prompt initiation of appropriate MDT is crucial for preventing disability and reducing transmission 6, 3
• Complete the full course of treatment to prevent relapse and drug resistance 2, 8
• Regular monitoring for adverse effects and reactional states is essential 1, 4
• Patient education about signs of reactions and importance of adherence to treatment 1