WHO Seventh Expert Committee (June 1997)
MDT regimens, resistance and definition of defaulters
Regimen for single skin lesion PB leprosy
Based on the results of a large multicentre randomized double-blind controlled clinical trial the Committee considered that a single dose of rifampicin 600 mg plus ofloxacin 400 mg and minocycline 100 mg, is an acceptable and cost-effective alternative regimen for the treatment of single skin lesion PB leprosy.
Other regimens for special situations
The Committee suggested that patients who do not accept clofazimine can be treated with a monthly administration of a combination consisting of 600 mg of rifampicin, 400 mg of ofloxacin and 100 mg of minocycline (ROM) for 24 months. For adult MB patients who cannot take rifampicin, the Committee recommended the daily administration of 50 mg of clofazimine, together with 400 mg of ofloxacin and 100 mg of minocycline for 6 months; followed by daily administration of 50 mg of clofazimine, together with 100 mg of minocycline or 400 mg of ofloxacin for at least an additional 18 months.
Rifampicin is by far the most bactericidal drug against M. leprae, and will still be the backbone of the MDT regimens in the foreseeable future. Consequently, all efforts should be made to prevent the emergence of rifampicin-resistant leprosy. To improve the surveillance of rifampicin-resistance, it may be useful to establish the genetic method for rapid detection of rifampicin-resistant strains at certain regional reference centres.
Defaulter: definition and management
A defaulter is a patient who started MDT but who has not received treatment for 12 consecutive months despite all attempts to trace the patient. If a defaulter patient returns to the health centre for treatment and shows signs of active disease such as new skin lesions, new nerve involvement or new nodules, he/she should be given a new course of MDT. In the absence of these, there is no need to restart MDT.