Editorials

Treatment of leprosy

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7454.1447 (Published 17 June 2004) Cite this as: BMJ 2004;328:1447
  1. Diana N J Lockwood ([email protected]), consultant leprologist,
  2. Bhushan Kumar ([email protected]), professor of dermatology
  1. Hospital for Tropical Diseases, London WC1E 6AU
  2. Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    The evidence base for newer drug combinations and shorter regimens is weak

    Leprosy still poses major therapeutic challenges. We have effective antibiotics to cure the infection, but the immune mediated peripheral nerve damage can continue long after effective antimicrobial treatment has started, and patients continue to be stigmatised. Effective management should therefore include treatment of nerve damage and reactions, prevention of disability, and reduction of stigma. The regimens recommended by the World Health Organization of six or 24 months' multidrug treatment (rifampicin, dapsone, and clofazimine) produce good clinical responses and low rates of relapse. The long term outcome for shorter regimens and other drug combinations, however, is not known. Testing for recent nerve damage and treating it with steroids is essential. Dermatologists already have an important role in treating patients in the large Indian and Brazilian cities, and this is likely to increase as leprosy programmes are integrated into primary care.

    Antimicrobial chemotherapy

    The WHO recommended multidrug regimen of rifampicin, clofazimine, and dapsone has been used since 1982. It is highly effective, and more than 11.2 million patients have received it.1 2 Patients receive rifampicin 600 mg monthly, dapsone 100 mg daily, with clofazimine 300 mg monthly and 50 mg daily added in for patients with multibacillary leprosy. The clinical classification uses the number of skin lesions for grouping patients into paucibacillary (five or fewer lesions) and multibacillary (more than five lesions) leprosy.3 Where possible, …

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