Leprosy elimination

MDT: duration of treatment FAQ

Will shortening the duration of MDT for multibacillary leprosy increase the risk of M. leprae developing resistance to rifampicin?

No, there is no risk, if the patient takes all the drugs prescribed in the MDT. Several studies have demonstrated that even a few doses of rifampicin kills all organisms susceptible to rifampicin. The naturally occurring rifampicin-resistant mutants are killed by the clofazimine/ dapsone combination. Therefore, the chances of finding any live bacilli after 12 doses of MDT are almost nil.

How can we minimize this risk to MB patients with high bacterial index?

Fortunately MB (multibacillary) patients with high bacterial index are becoming rare in most of the leprosy programmes. WHO estimates that their proportion among newly detected cases is less than 15%. There is evidence that 3 to 6 months administration of MDT kills all live organisms. Secondly more and more programmes are classifying leprosy patients on clinical criteria as skin smear services are either not available or not reliable. If a programme can identify patients with high bacterial index and those at the risk of developing reactions/neuritis by clinical and/or bacteriological examination, then such selected patients may be kept on surveillance for 1 to 2 years to diagnose deterioration and reactions as early as possible. Any patient showing signs of deterioration can be given one more course of 12 month MDT. Patients with reactions can be successfully managed by a standard course of prednisolone. The most important activity will be to educate the patients at the time of stopping treatment about the signs/symptoms of relapse and request them to report immediately to the nearest health centre when such problems arise.