Leprosy Mailing List – October 21, 2019
Ref.: (LML) Request advice on a lepromatous patient treatment
From: Ben Naafs, Munnekeburen, the Netherlands
Dear colleagues,
We received copies from an internal discussion in the Philippines about how to treat patients who do not tolerate MDT - the WHO regimen (LML, October 7, 2019). One of the suggestions was from Ma. Luisa Venida who wrote: "I have successfully treated specially difficult patients not tolerating the WHO regimen with combination of Lymecycline 600mg and an immunomodulator TRANSFER FACTOR 300mg in high doses of 6-8caps/ day effectively for 3 months to as much as 6 months if necessary. They are just maintained afterwards with Transfer factor 600mg until AFS negative on slit skin smear".
We have no experience with Transfer factor and Lymecycline.
Most probably Lymecycline works against M leprae. But should only be in combination therapy. Most of other combination with Minocycline, Ofloxacin (if not resistant), Clarithromycin work, it is always I think good to add clofazimine. It is good of Joel Almeida to remind us of the risks of low dose Rifampicin and the selection of resistant strains. May be Moxifloxacin, Rifapentine, Bedaquiline are other possibilities. But nothing has been proved yet to be better than the others, may be that Bedaquiline has an influence on the always present persisters in lepromatous leprosy.
Concerning Transfer Factor, I have no experience. William Faber has and was not positive. Most writers were not positive however claim that it could be (see annex). The last paper I found about Transfer Factor was from 2012 and it was not positive. If anybody has positive experiences please share them with us.
Regards
Ben
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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