Treatment

For purposes of treatment leprosy disease is seperated into two catagories:
Paucibacillary (PB): the number of M. leprae in the body is small (less than 1 million) and a skin smear test is negative. The patient presents five or fewer skin lesions. Most cases of leprosy are PB.
Multibacillary (MB): M. leprae can multiple in the body almost without any check and is thus present in high numbers. The bacillus has likely spread to almost all areas of skin and peripheral nerves. A skin smear test is positive and the patient presents more than five skin lesions.

A multidrug treatment regimen is recommended for leprosy because resistance to the primary drug used has become common in the past twenty years.

Dapsone is the primary drug indicated for treatment of leprosy and it is almost always accompanied by at least one other medication. It works by preventing the formation of folic acid, thereby inhibiting the organism's replication. Two of the most common additional drugs for leprosy management are Rifampin and Clofazimine. Rifampin is one of the main drugs used in treatment of tuberculosis and Clofazimine is an antimicrobial that works by unknown mechanisms.

All three medications are taken orally and can be administered on an out-patient basis. Dose, and duration of these three medicines varies according to stage of the disease and whether the patient is an adult or child. Multidrug regimens are recommended for 6 months (for paucibacillary), to 2 years (for multibacillary).

Treatment Summary:


Drug Name Dapsone (Avlosulfon): Bactericidal. Mechanism of action is the prevention of formation of folic acid, inhibiting bacterial growth. Part of a 2-drug regimen for treatment of paucibacillary leprosy; part of a 3-drug regimen for treatment of multibacillary leprosy.
Adult Dose Paucibacillary leprosy: 100 mg/day orally for 6 months Multibacillary leprosy: 100 mg/day orally for 24 months
Pediatric Dose 1-2 mg/kg/day orally; not to exceed 100 mg/day
Contraindications Documented hypersensitivity
Pregnancy Safety for use during pregnancy has not been established.
Precautions Perform weekly blood counts (first month), then perform white blood cell counts monthly (for 6 months), then semiannually; discontinue if significant reduction in platelets, leukocytes, or hematopoiesis occurs. Peripheral neuropathy can occur (rare) Phototoxicity may occur when exposed to UV light.


Drug Name

Rifampin (Rifadin, Rimactane): For use in combination with at least 1 other antituberculous drug. Inhibits DNA-dependent bacterial RNA polymerase. Cross-resistance may occur. Treat for 6-9 months or until 6 months have elapsed from time of negative sputum test. Part of 2-drug regimen for treatment of paucibacillary leprosy; part of 3-drug regimen for treatment of multibacillary leprosy.

Adult Dose Paucibacillary leprosy: 600 mg/month orally or IV for 6 months Multibacillary leprosy: 600 mg/month orally or IV for 24 months
Pediatric Dose 10-20 mg/kg orally or IV; not to exceed 600 mg/day
Contraindications Documented hypersensitivity
Pregnancy Safety for use during pregnancy has not been established.
Precautions If patient has liver disease serious health risks occur such as cerebral hemorrhage or death; may cause red-orange discoloration of urine, feces, saliva, sweat, sputum, and tears

 

Drug Name

Clofazimine (Lamprene): Inhibits mycobacterial growth, binds preferentially to mycobacterial DNA. Has antimicrobial properties, but mechanism of action is unknown. Part of 3-drug regimen for treatment of multibacillary leprosy.

Adult Dose 50 mg/day orally for 24 months in combination with Dapsone and Rifampin
Pediatric Dose 1 mg/kg/day orally in combination with Dapsone and Rifampin
Contrindications Documented hypersensitivity
Interactions Dapsone may inhibit anti-inflammatory activity of clofazimine
Pregnancy Safety for use during pregnancy has not been established.
Precautions Patients should be warned that clofazimine may discolor skin, body fluids, and excrement; color ranges from pink to brownish-black; caution in patients with GI problems (eg, abdominal pain, diarrhea); skin discoloration due to drug may result in depression or suicide; apply oil to skin for dryness.

Charts adapted from Snyder and Larocco www.emedicine.com
 

If caught early, treatment really works!

Before and after 6 months of MDT:
www.med.sc.edu:85/ fox/mycobacteria.htm (copyright CDC/TDR)
However, damaged nerves and tissues cannot regrow. Thus, if left untreated for too long, disfigurment from leprosy can be permanent, unless it can be repaired with reconstructive surgery.