Wednesday, January 10, 2018

(LML) Chemoprophylaxis in Leprosy

Leprosy Mailing List – January 10,  2017

Ref.:    (LML) Chemoprophylaxis in Leprosy

From:  Ajit P, Mumbai, India

Respected Sir,

With regards to the excellent observation of dr Lockwood regarding single dose rifampicin prophylaxis
, my suggestion would be instead of single dose rifampicin prophylaxis should be with at least three or even six or twelve-monthly doses of mrm i.e. (moxifloxacin minocycline and rifampicin) given monthly to not just contacts but if possible in a universal manner in countries where Hansen is prevalent.

Before elaborating further I agree that the idea may seem foolhardy
, may be economically unfeasible, logistically impractical etc, but here is my rationale:
My experience for last three years tells me that the monthly rifampicin moxifloxacin minocycline regimen in Bombay leprosy project works awesome in patients
. We give it for 12 months but I think in cases it should be for 24 months at least. These antibiotics are for a large part super safe especially when you are giving them monthly i.e. just 12 pills in a year ( Rifampicin is widely used daily in tuberculosis, moxifloxacin is used left right center by general physicians in India, we dermatologists use minocycline and its adverse effects are seen mainly after daily long term administration).

This regimen includes multiple cidal agents.
If given monthly for six or twelve months it may simply break the transmission chain of M leprae. In pediatric  patients, we could use instead of minocycline  clarithromycin or just give rifampicin and moxifloxacin.

These do not in any way represent thoughts of Bombay leprosy project and are my own thoughts.

Dr Ajit

Dermatologist Bandra Mumbai

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