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WHO Model Prescribing Information: Drugs Used in Leprosy
(1998; 28 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentIntroduction
View the documentDiagnosis of leprosy
View the documentClassification of leprosy
View the documentTreatment of leprosy
View the documentTreatment of lepra reactions
View the documentTreatment of neuritis
View the documentTreatment of eye complications
View the documentManagement of nerve damage
View the documentTreatment of leprosy during pregnancy and lactation
View the documentTreatment of patient with concomitant active tuberculosis
View the documentTreatment of patients with concomitant HIV infection
Open this folder and view contentsTreatment of leprosy in special situations
Open this folder and view contentsDrug data sheets
 

Treatment of leprosy

Several drugs are used in combination in multidrug therapy (MDT). (See table) These drugs must never be used alone as monotherapy for leprosy.

Dapsone, which is bacteriostatic or weakly bactericidal against M. leprae, was the mainstay treatment for leprosy for many years until widespread resistant strains appeared. Combination therapy has become essential to slow or prevent the development of resistance. Rifampicin is now combined with dapsone to treat paucibacillary leprosy. Rifampicin and clofazimine are now combined with dapsone to treat multibacillary leprosy.

A single dose of combination therapy has been used to cure single lesion paucibacillary leprosy: rifampicin (600 mg), ofloxacin (400 mg), and minocycline (100 mg). The child with a single lesion takes half the adult dose of the 3 medications.

WHO has designed blister pack medication kits for both paucibacillary leprosy and for multibacillary leprosy. Each easy-to use kit contains medication for 28 days. The blister pack medication kit for single lesion paucibacillary leprosy contains the necessary medication for the one time administration of the 3 medications.

Any patient with a positive skin smear must be treated with the MDT regimen for multibacillary leprosy. The regimen for paucibacillary leprosy should never be given to a patient with multibacillary leprosy. Therefore, if the diagnosis in a particular patient is uncertain, treat that patient with the MDT regimen for multibacillary leprosy.

Ideally, the patient should go to the leprosy clinic once a month so that clinic personnel may supervise administration of the drugs prescribed once a month. However, many countries with leprosy have poor coverage of health services and monthly supervision of drug administration by health care workers may not be possible. In these cases, it may be necessary to designate a responsible third party, such as a family member or a person in the community, to supervise the monthly drug administration. Where health care service coverage is poor and supervision of the monthly administration of drugs by health workers is not possible, the patient may be given more than the 28 days supply of multidrug therapy blister packs. This tactic helps make multidrug therapy easily available, even to those patients who live under difficult conditions or in remote areas. Patients who ask for diagnosis and treatment are often sufficiently motivated to take full responsibility for their own treatment of leprosy. In this situation, it is important to educate the patient regarding the importance of compliance with the regimen and to give the patient responsibility for taking his or her medication correctly and for reporting any untoward signs and symptoms promptly. The patient should be warned about possible lepra reactions.

WHO Recommended treatment regimens

6 month regimen for Paucibacillary (PB) Leprosy

 

Dapsone

Rifampicin

Adult
50 - 70 kg

100 mg
Given daily

600 mg
Given once a month under supervision

Child
10 - 14 yearsa

50 mg
Given daily

450 mg
Given once a month under supervision

a Adjust dose appropriately for child less than 10 years. For example, dapsone 25 mg daily and rifampicin 300 mg given once a month under supervision

12 month regimen for Multibacillary (MB) Leprosy

 

Dapsone

Rifampicin

Clofazimine

Adult
50 - 70 kg

100 mg
Given daily

600 mg
Given once a month under supervision

50 mg
Given daily

AND

300 mg
Given once a month under supervision

Child
10 - 14 yearsb

50 mg
Given daily

450 mg
Given once a month under supervision

50 mg
Given every other day

AND

150 mg
Given once a month under supervision

b Adjust dose appropriately for child less than 10 years. For example, dapsone 25 mg daily, rifampicin 300 mg given once a month under supervision, clofazimine, 50 mg given twice a week, and clofazimine 100 mg given once a month under supervision

Single Lesion Paucibacillary (SLPB) Leprosy (one time dose of 3 medications taken together)

 

Rifampicin

Ofloxacin

Minocycline

Adult
50 - 70 kg

600 mg

400 mg

100 mg

Child
5 - 14 yearsc

300 mg

200 mg

50 mg

c Not recommended for pregnant women or children less than 5 years

 

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