WHO Seventh Expert Committee (June 1997)
BCG, Duration of treatment, MDT delivery systems
The widespread application of BCG is likely to be a contributing factor to the decline in leprosy incidence observed in certain populations. However, repeated doses of BCG to prevent leprosy are not recommended on the grounds of poor cost-effectiveness, lack of acceptability to recipients, operational difficulties, and the fact that BCG is contraindicated in symptomatic HIV individuals.
Shortening duration of MDT regimen for MB leprosy
The results from both nude mouse experiments and a clinical trial have demonstrated that the rifampicin-resistant mutants in an untreated lepromatous patient are likely to be eliminated by 3 to 6 months of treatment with the dapsone-clofazimine component in MDT regimen. From the operational point of view, the duration of MDT for MB leprosy is still very long, which adversely affects the implementation of MDT among all patients in need of treatment. When the Study Group (1981) designed the MDT regimens, MB leprosy referred to those patients who had a BI of 2 at any site in the initial skin smears. Currently MB leprosy includes all smear-positive patients, as well as patients with more than five lesions. Among the newly detected cases, the skin-smear positive patients represent only 12.5% of the total number. Based on all the available information, the Committee accepted that it is possible to reduce the duration of the current MDT regimen for MB leprosy to 12 months without significantly compromising its efficacy.
Flexible MDT delivery system
Due to poor coverage of the health services in most of the leprosy-endemic countries, supervision of the monthly administered drugs by health workers may not always be possible. In that case, more than one month's supply of MDT blister packs may be given to the patient, provided he or she is given appropriate information and guidance regarding the dosage, rhythm and necessary duration of treatment, and is advised to report any untoward signs/symptoms promptly.