What is the recommended dose of Rifampicin (antibiotic) for the treatment of leprosy?

Rifampicin Dose for Leprosy

For leprosy treatment, rifampicin is administered at 600 mg once monthly as a supervised dose in combination with daily dapsone for paucibacillary disease, or with daily dapsone and clofazimine for multibacillary disease. 1, 2

Standard Dosing Regimens

Paucibacillary (PB) Leprosy

• Rifampicin 600 mg once monthly (supervised) combined with dapsone 100 mg daily for 6 months total duration 1
• Treatment is stopped after completing the 6-month course 3
• This regimen achieves 72-94% inactive disease rates, with higher success when extended to 12 months 3

Multibacillary (MB) Leprosy

• Rifampicin 600 mg once monthly (supervised) 1, 2
• Combined with clofazimine 300 mg once monthly (supervised) plus 50 mg daily (self-administered) 1
• Plus dapsone 100 mg daily (self-administered) 1
• Duration: 24 consecutive monthly doses (2 years) 2

Single Lesion Paucibacillary Disease

• Single-dose regimen: Rifampicin 600 mg + ofloxacin 400 mg + minocycline 100 mg given as one supervised dose for adults 1

Evidence Supporting Monthly Dosing

The once-monthly 600 mg rifampicin schedule demonstrates equivalent efficacy to daily rifampicin regimens while offering superior tolerability and cost-effectiveness. 4

• Monthly rifampicin (1200 mg) was compared to daily rifampicin (450 mg) in combination with dapsone, showing practically identical clinical, histopathological, and bacteriological improvements at 6 months 4
• The once-monthly schedule costs approximately one-tenth of daily rifampicin regimens 4
• Monthly administration allows for supervised dosing, ensuring compliance and preventing dapsone resistance 4

Pediatric Dosing Considerations

• Dose adjustments are required for children, though specific pediatric dosing was not detailed in the leprosy-specific evidence provided 1
• The standard adult dose of 600 mg monthly should be weight-adjusted for pediatric patients 1

Clinical Outcomes and Efficacy

Rifampicin produces rapid bacteriological regression, with significant decreases in bacterial and morphological indices within the first week of treatment. 5

• When rifampicin 1200 mg monthly was combined with daily clofazimine and dapsone, 7 patients became morphological index (MI) negative at one month, and 13 at nine months 5
• The ROM regimen (rifampicin, ofloxacin, minocycline) for 24 months showed no relapses in patients followed for 5+ years 2
• Three-drug regimens including rifampicin prevent emergence of erythema nodosum leprosum (ENL) reactions that occur with dual therapy 5

Important Clinical Considerations

Supervision Requirements

• All rifampicin doses in leprosy treatment must be directly observed to ensure compliance and prevent resistance 1, 4
• Monthly supervised dosing is more practical for large-scale programs than daily administration 4

Combination Therapy Rationale

• Rifampicin should never be used as monotherapy for leprosy 1
• The addition of clofazimine to rifampicin-dapsone regimens prevents ENL reactions and provides additional bactericidal activity 5
• Multi-drug therapy prevents the development of rifampicin resistance 4

Treatment Duration Pitfalls

• Stopping PB treatment at 6 months without adequate follow-up may result in disease reactivation - 18 of 25 active cases required retreatment when therapy was stopped prematurely 3
• Extending PB treatment to 12 months (6 months rifampicin plus 6 additional months of dapsone) improves outcomes to 94.9% inactive disease 3
• MB leprosy requires the full 24-month course to prevent relapse 2

Tolerability Profile

• Monthly rifampicin dosing is better tolerated than daily administration 4
• Clofazimine causes skin pigmentation in all recipients, which patients should be counseled about 2
• The 600 mg monthly dose has proven safe and well-tolerated across multiple international trials 3, 4