The management of leprosy depends on treatment by chemo-therapeutic agents, immunotherapy, and physical, social, and psychological rehabilitation.
The goals of chemotherapy against leprosy are to (a) stop infection, (b) reduce morbidity, (c) prevent complications, and ( d) eradicate the disease. Dapsone was the first effec-tive chemotherapeutic agent used against leprosy. Earlier it was used as a monotherapy, but it resulted in development of resistance against the drug by lepra bacilli. Hence since 1981, the World Health Organization (WHO) has advo-cated multiple drug therapy (MDT) against leprosy, as in tuberculosis.
Multiple drug therapy (MDT) against leprosy: The MDTquickly decreases contagiousness of the disease, reduces relapse and reactions, and reduces disabilities. Moreover, MDT pre-vents dapsone resistance. The duration of treatment varies from 6 months to 2 years. The recommendations of WHO for treatment of leprosy in adults are as follows:
1. Single skin lesion: A single dose of the drug which includesrifampicin 600 mg, ofloxacin 400 mg, and minocycline 100 mg.
2. Paucibacillary disease: Dapsone 100 mg daily and rifampi-cin 600 mg once a month given for 6 months.
3. Multibacillary disease: Rifampin (rifampicin) 600 mg oncea month, dapsone 100 mg daily, clofazimine 300 mg once a month, and 50 mg daily are given for 1 year.
A minimum 2 years follow-up for paucibacillary and 8 years for multibacillary cases is required to detect any relapse. Treatment schedule for children consists of dapsone (2 mg/kg) daily, clofazimine (6 mg/kg) once a month under supervision and 1 mg/kg daily self-administered, and rifampin (10 mg/kg) once a month.
Reactions during treatment with MDT are a major problem. These reactions need urgent treatment, failing which they can give rise to irreversible deformities. Early diagnosis and timely initiation of anti-inflammatory measures are important. MDT is not stopped during reactions and continued at full doses without interruption.
Many immunotherapy agents have been evaluated for treat-ment of leprosy. These include immunomodulatory drugs, transfer factor, acetoacetylated M. leprae, and delipidified cell components of M. leprae. These agents have shown to enhance CMI, which results in increased killing and rapid clearing of dead lepra bacilli. Immunotherapy in combination with chemotherapy has shown to be more beneficial, better toler-ated by patients, and is not associated with increased lepra reactions.
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