Leprosy Mailing List – August 22, 2021
Ref.: (LML) Smear positivity after one year course of MB MDT
From: Wim van Brakel, Amsterdam, the Netherlands
Dear Pieter,
In response to Dr Rao's query, I would advise that 1 year of MB MDT is sufficient. Smear positivity at 1 year is not linked directly to treatment outcome or prognosis. Generally, the bacteria seen at 1 year are already dead, but they continue to show up in smear. The decline in smear positivity until the smear becomes negative can take years, but there is no need to continue treatment. Ample evidence shows that the decline takes place regardless of whether MDT is continued. It is advisable to follow the government guidelines on treatment of MB leprosy.
There is one caveat. A limited body of evidence suggests that patients with an initial BI of 4+ or higher have an increased risk of a (late) relapse. Some practitioners would therefore use a 2-year MB-MDT regimen for such patients. However, to my knowledge, the benefit of this has not been conclusively established.
With kind regards,
Wim van Brakel, MD MSc PhD
Medical Director NLR
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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