Effective treatment of leprosy is complex and requires much experience to obtain the best results. Problems of resistant leprosy now require that multiple drug therapy be used and involve:

• for paucibacillary disease: dapsone and rifampicin for 6 months

• for multibacillary disease: dapsone, rifampicin and clofazimine for 2 years. Follow-up for 4-8 years may be necessary.

Dapsone, a bacteriostatic sulphone (related to sulphonamides, and acting by the same mechanism, see p. 231), has for many years been the standard drug for the treatment of all forms of leprosy.

Irregular and inadequate duration of treatment with a single drug have allowed the emergence of resistance, both primary and secondary, to become a major problem. Dapsone is also used to treat dermatitis herpetiformis, and is given for Pneumocystis carinii and (with pyrimethamine) malaria prophylaxis. The t/2 is 27 h. Adverse effects range from gastrointestinal symptoms to agranulocytosis, haemolytic anaemia and generalised allergic reactions that include exfoliative dermatitis.

Rifampicin (see above) is bactericidal, and is safe and effective when given once monthly. This long interval renders feasible the directly observed administration of rifampicin which the above regimens require.

Clofazimine has a leprostatic action and an antiinflammatory effect that prevents erythema nodosum leprosum. It causes gastrointestinal symptoms. Reddish discolouration of the skin and other cutaneous lesions also occur, and may persist for months after the drug has been stopped. The tV2 is 70 days.

Other antileprotics include ethionamide and pro-thionamide. Thalidomide (see Index), despite its notorious past, still finds a use with corticosteroid in the control of allergic Iepromatous reactions.

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