Leprosy Mailing List – January 18, 2020
Ref.: (LML) Dapsone allergy and MB treatment
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
Thanks to Dr. Shen Jianping for his very relevant question regarding Dapsone allergy and multidrug MB treatment (LML, January 6, 2020). I think it is good that all Chinese leprosy patients are checked for the 1301 gene-locus. Dapsone Syndrome is a terrible occurrence. But as pointed out having this gene locus does not always lead to the Dapsone syndrome.
Treating Multibacillary patients with only 2 drugs was at start of the MDT considered insufficient with no clinical evidence. But we know now that highly positive patients in a high endemic area after many years may relapse. Even in non-endemic area's as the Netherlands, we have seen relapses we considered from persisters. We still do not know how we can eradicate those persisters. Except maybe with a preventive treatment. Then still resistance may have occurred.
The paper from Yunnan fits in with my own feeling. PB as WHO advised will be treated with 3 drugs with the mentioned locus they will get 2 drugs. Which most likely will be enough. But my feeling is Rifampicine with Clofazimine together is not enough for MB patients. Without proper evidence, the WHO has neither, I would add minocycline or another 3rd drug. And then still we may have relapses.
My excuses for this personal answer, I think we have no sufficient evidence from trials and worse no good follow up.
We wish you a good Chinese New Year
Dr Ben Naafs
Dermatovenerologist
Leprologist since 1973. Ethiopia, Zimbabwe, The Netherlands, Brazil. Tanzania
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
You received this message because you are subscribed to the Google Groups "Leprosy Mailing List" group.
To unsubscribe from this group and stop receiving emails from it, send an email to leprosymailinglist+unsubscribe@googlegroups.com.
To view this discussion on the web, visit https://groups.google.com/d/msgid/leprosymailinglist/c6c2b349-6be1-4ad8-b4d1-2459d65ce7a9%40googlegroups.com.
No comments:
Post a Comment