Leprosy

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General Treatment of Leprosy

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It mainly affects the  skin,  the  peripheral  nerves  and  the  mucous  membranes.  Leprosy  is  the  most common  cause  of  peripheral neuritis in the world.  

Clinical presentation 

Presence of any one among the three cardinal signs of leprosy below: 

  • Skin patch with loss of sensation 
  • One or more enlarged peripheral nerves 
  • Presence of leprosy bacilli–positive smear  

Classification of Leprosy   

  • Multibacillary (MB) Leprosy   
    • Patients with six or more leprosy skin lesions  
    • Positive skin smear  
  • Paucibacillary (PB) Leprosy   
    • Patients with one to five leprosy skin lesions   
    • Negative skin smear  

Note 

  • If there is any doubt regarding the classification, the patient should be classified and treated as a multi-bacillary case.  

Pharmacological Treatment 

Patients should be treated by multidrug combination therapy; dosage may depend with classification  and whether patient is adult or children 

Table 7.8 Treatment of Leprosy 

Classification

Medicine dosage 

Duration of treatment 

Adult MB:  15years and  above 

Day 1: Rifampicin 600mg (2x 300mg) + Clofazimine 300mg (3 x 100mg) + Dapsone 100mg.

Daily Treatment: Day 2–28, Clofazimine 50mg + Dapsone 100mg

 12 blister packs to be taken within a period of between
12–18 months

Child MB:  below 15 years 

Day 1: Rifampicin 450mg (3 x 150mg) + Clofazimine 150mg (3 x 50mg) + Dapsone 50mg.

Daily Treatment: Day 2–28 Clofazimine 50mg every other day + Dapsone 50mg daily.

12 blister packs to be taken  within a period of between  12–18 months   

Adult PB:  15 years and  above 

Day  1:  Rifampicin  600mg (2x  300mg)  + Clofazimine  300mg (3    x    100mg) + Dapsone 100mg.    

Daily  Treatment:  Day  2–28,  Clofazimine  50mg  +  Dapsone  100mg   

6 blister packs to be taken  within a period of between  6–9 months   

Child PB:  below 15 years 

Day  1: Rifampicin 450mg (3 x 150mg) + Clofazimine 150mg (3 x 50mg) + Dapsone 50mg.

Daily Treatment: Day 2–28    Clofazimine 50mg every other day + 
Dapsone 50mg daily. 

6 blister packs to be taken  within a period of between  6–9 months   

Treatment of Leprosy in Special Cases

Tuberculosis:  Patients  suffering  from  both  tuberculosis  and  leprosy  require  appropriate  anti- Tuberculosis therapy in addition to the MDT. Rifampicin must be given in the dose required for the  treatment of tuberculosis. Once the intensive phase of anti TB treatment is completed, the patient  should continue with his/her monthly rifampicin for leprosy treatment.

There are two types of reactions 

  • Reverse Reaction or type I reaction  
  • Erythema  Nodosum  Leprous  (ENL)  or  type  II  reaction  (For  detail  refer  Manual  for  the Management of Tuberculosis and Leprosy in Tanzania)   

Treatment  of  Reaction:  Depending  on  severity,  treatment  of  reverse  reaction  is  by  giving  anti-inflammatory drugs or corticosteroids usually prednisolone for a prolonged period.   

Note: Health care worker should communicate with DTLC and RTLC when suspect leprosy reaction