Multidrug therapy in leprosy.

Leprosy is an ancient disease, which was treated by local application of chaulmoogra/hydnocarpus oil during prechemotherapeutic era. Since 1940, dapsone was the only chemotherapeutic agent used for treatment of leprosy for about three decades. Prolonged, interrupted and inadequate use of dapsone monotherapy, leads to development of dapsone-resistant cases. Usefulness of clofazimine was known in 1962. Introduction of rifampicin--a powerful bactericidal drug in 1970 has opened the avenues of multidrug therapy to treat leprosy. Multidrug therapy recommended by World Health Organisation came into practice after 1982. The regimen followed now is for duration of 6 months in paucibacillary and for the duration of 12 months in multibacillary cases. It is proven to be safe and effective. Multidrug therapy for leprosy cases is available in the form of blister calender packs and is available free of cost at all government health facilities. Although more new drugs such as ofloxacin, minocyclin, clarithromycin, etc, are known now but they are used as alternative drugs if a component of combination in multidrug therapy becomes contra-indicated. This article brings the details of various drugs used under multidrug therapy, their characteristics, side-effects, regimens and alternative drugs available for treating leprosy.

Prevention of disability in leprosy.

Leprosy is curable now-a-days if initiatives are taken for prevention of disability along with complete and regular chemotherapy. Common disabilities encountered in leprosy are: Claw hand, foot drop, lagophthalmos, plantar ulcers and depressed bridge of nose. Objectives of prevention of disabilities are preservation of nerve function, preservation of vision, to regain functional ability and self-esteem. Measures to prevent disabilities include early diagnosis and treatment with effective chemotherapy, to train leprosy cases to perform self-care practices, providing them with protective aids and referring the cases for surgery if indicated. Lepra reactions are episodes of sudden increase in the activity of the disease. Lepra reactions are treated by bed rest, analgesics rest to affected nerve by splints and a suggested course of prednisolone. Besides, leprosy-affected persons should be encouraged for self-care practices. Counselling and holding care and concern camps (POD camps) are very much integrated wtih the prevention of disabilities.

Follow-up study of pauci-bacillary leprosy on-multi-drug regimen.

One hundred and twenty nine newly registered cases of pauci-bacillary leprosy were put on Dapsone daily and Rifampicin once a month and were followed up for one year. Out of 129 cases, 108 (83.7%) were found to be clinically active at the end of one year of multidrug treatment (MDT). In 25 out of these 108 cases, skin biopsy was done and well defined granulomas were seen after therapy in 11 patients (44%).