What is the recommended treatment regimen for a patient diagnosed with leprosy?

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Last updated: February 2, 2026 • View editorial policy

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Leprosy Treatment

For leprosy, the World Health Organization-recommended multidrug therapy (MDT) is the definitive treatment: rifampin 600mg monthly supervised plus dapsone 100mg daily for paucibacillary disease (6 months), or rifampin 600mg monthly supervised, clofazimine 300mg monthly supervised plus 50mg daily, and dapsone 100mg daily for multibacillary disease (12 months). 1, 2, 3

Classification and Treatment Selection

The treatment regimen depends on disease classification:

  • Paucibacillary leprosy (tuberculoid, indeterminate, borderline tuberculoid with <5 skin lesions): Rifampin 600mg monthly supervised + dapsone 100mg daily for 6 months 1, 4
  • Multibacillary leprosy (lepromatous, borderline lepromatous, borderline with ≥5 skin lesions): Rifampin 600mg monthly supervised + clofazimine 300mg monthly supervised plus 50mg daily + dapsone 100mg daily for 12 months 1, 2, 3

Pre-Treatment Screening Requirements

Before initiating therapy, mandatory screening includes:

  • G6PD deficiency testing before dapsone due to hemolytic anemia and methemoglobinemia risk 1, 2, 3
  • Baseline ECG before clofazimine to assess QT interval 2, 3
  • Baseline complete blood count and liver function tests 2, 3

Monitoring During Treatment

Regular monitoring is essential:

  • Complete blood count and liver function tests during dapsone therapy to detect hemolytic anemia, methemoglobinemia, nausea, and hepatotoxicity 2, 3, 4
  • ECG monitoring at 2 weeks after clofazimine initiation and when adding any QT-prolonging medications 2, 3
  • Clinical assessment for treatment response, expecting lesion flattening by 4-6 weeks 2, 3

Critical Treatment Principles

MDT must not be interrupted for skin complications, wound healing, or leprosy reactions. 2, 3 This is a common pitfall that worsens outcomes.

Managing Leprosy Reactions

Leprosy reactions are immunological phenomena distinct from treatment failure:

  • Type 1 reversal reactions: Treat with corticosteroids while continuing MDT 2, 3
  • Type 2 erythema nodosum leprosum: Requires anti-inflammatory management but continuation of MDT 2, 3

These reactions require adding anti-inflammatory therapy, not stopping antibiotics. 2, 3

Special Populations

Pregnancy

Treatment should continue during pregnancy as benefits outweigh risks, with close monitoring required. 2, 3 All three drugs (rifampin, dapsone, clofazimine) can be used.

Pediatric Patients

Clofazimine has been well-tolerated in pediatric leprosy trials at 1-2 mg/kg/day (maximum 100mg daily). 3 Dapsone and rifampin doses are correspondingly reduced based on weight. 4

Medication-Specific Guidance

Dapsone

  • Dosage: 100mg daily in adults, proportionally reduced in children 4
  • Side effects: Hemolysis, methemoglobinemia, nausea, vomiting 3, 4
  • Influenced by acetylation rates; high acetylators may require dose adjustment 4

Clofazimine

  • Dosage: 50-100mg daily with meals or milk to maximize absorption 3
  • Available as 100mg capsules that cannot be split 3
  • Causes pink to brownish-black skin discoloration in 75-100% of patients within 1-4 weeks, resolving 6-12 months after stopping 3
  • Other adverse effects: Ichthyosis, gastrointestinal intolerance, QT prolongation 3

Rifampin

  • Dosage: 600mg monthly supervised (can be given daily if resources permit) 1, 4

Dapsone Resistance

Suspect secondary dapsone resistance when lepromatous or borderline lepromatous patients relapse clinically and bacteriologically with solid-staining bacilli in new active lesions. 4 If no response occurs within 3-6 months of supervised therapy, resistance should be considered confirmed and alternative drugs used. 4

Common Pitfalls to Avoid

  • Premature discontinuation due to leprosy reactions worsens outcomes; reactions require anti-inflammatory therapy while continuing MDT 2, 3
  • Failure to screen for G6PD deficiency before dapsone can lead to life-threatening hemolytic anemia 1, 2, 3
  • Inadequate QT monitoring with clofazimine, especially when combined with other QT-prolonging medications 2, 3
  • Confusing leprosy reactions with treatment failure leads to inappropriate MDT discontinuation 2, 3

References

1
Guideline

Leprosy Diagnosis and Treatment

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Treatment of Non-Healing Wounds Secondary to Hansen's Disease

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Leprosy Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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