[5-year assessment of daily multi-drug therapy of leprosy in Guadeloupe since 1980]. / Bilan à 5 ans de la polychimiothérapie quotidienne de la lèpre en Guadeloupe depuis 1980.

In Guadeloupe, from January 1980 to December 1984, 420 leprosy patients were put under daily multidrug therapy: 10 mg/kg RMP plus 100 mg DDS during six months for paucibacillary patients, 10 mg/kg RMP plus 100 mg DDS during 24 months supplemented during the 12 first months with 10 mg/kg of a thioamide, ethionamide or protionamide, for multibacillary patients. The approval to the treatment was satisfactory in all the patients with active leprosy, new cases and relapse cases, less in the inactive patients already treated with dapsone only. The patients's compliance to treatment was satisfactory too. The lepra reactions were observed with a 19% frequency which is not different of the 15% frequency of lepra reactions observed in patients treated with DDS only. Hepatitis were observed only in multibacillary patients treated with PTH and RMP with a 14% frequency. Discontinuing treatment with RMP and PTH but not DDS resulted in recovery. When RMP was resumed without PTH, the hepatitis did not recur. All patients responded favorably under multidrug therapy and no relapse was observed among the 45 paucibacillary patients after a four year-surveillance and among the 16 multibacillary patients after a three year-surveillance.

[Epidemiology of leprosy in Guadeloupe from 1970 to 1984]. / Epidémiologie de la lèpre en Guadeloupe de 1970 à 1984.

Analysis of computerized data compiled according to the OMSLEP system in the leprosy control service in Guadeloupe has shown that from 1970 to 1984, 80% of the patients were detected by passive case-finding (symptomatic patients), 10% by active case-finding among the school population and 10% by active case-finding among the house-hold contacts of known patients. During the same period of time, global incidence of new cases of leprosy declined from 24 to 11 per 100,000 inhabitants. The decline was greater for paucibacillary cases (y = -0,94) than for multibacillary cases (y = -0,45), and much greater among persons under 15 years of age (y = -3,22) than among those older ones (y = -0,67). Simultaneously 118 relapses, an annual incidence of 1,3%, were observed among the multibacillary patients previously treated by dapsone monotherapy for five years or more. All cases the biopsies of whom were inoculated for drug sensitivity testing in the mouse foot pad yielded dapsone-resistant M. leprae. The proportions of relapses among the annual sources of infection increased from 16% in 1970 to 47% in 1984. Chemoprophylaxis of relapses among multibacillary patients already treated for more than five years with dapsone monotherapy is one of the priorities for leprosy control in Guadeloupe.

[Acceptability, compliance and tolerance of daily polychemotherapy by leprosy patients in Guadeloupe]. / Acceptabilité, assiduité et tolérance d'une polychimiothérapie quotidienne de la lèpre en Guadeloupe.

From January 1980 to December 1984, 418 leprosy patients were treated in Guadeloupe with a daily multiple drug regimen using rifampin as an essential drug. The analysis of the data collected during this period of times gives the possibility of estimating the patient's approval, tolerance and attendance to this treatment. The approval is satisfactory in new cases of leprosy and in ancient cases relapsed under dapsone monotherapy but less in inactive ancient patients already treated with dapsone monotherapy. Attendance of the 418 patients to the multiple drug regimen is satisfactory too and similar to the attendance of patients treated with dapsone monotherapy in Guadeloupe and to the attendance of patients with monthly multiple drug regimen in another Caribbean country. Reactions did not occur with higher gravity or frequency than in patients under dapsone monotherapy. The high incidence of hepatitis (14%) due to the toxicity of protionamide in the combination rifampin-protionamide-dapsone make obligatory the monthly assessment of the liver functions in multibacillary patients treated with such a drug combination.