Leprosy Mailing List – January, 27th, 2010
Ref.: Alternative regimens for multi-drug therapy (MDT) in leprosy
From: Diana Lockwood,
Dear Salvatore,
In Reply to Dr Gilead's request (LML Jan. 19th, 2010).
The whole topic of alternative regimens for MDT is given too little attention. I think that the level of adverse effects due to dapsone has been under-recognised and we are starting to see significant rates of adverse effects when we look for them. Patricia Deps (Lepr Rev. 2007 Sep;78(3):216-22.) has reported that 45% of Brazilian patients had adverse effects with leprosy MDT, 43.8% to Dapsone, 12.3% to Rifampicin and 9.2% to Clofazimine. In a study I am currently doing in
If a patients cannot tolerate Dapsone or Clofazimine then using single dose monthly Rifampicine, Ofloxacine and Minocicline (ROM) is an option. The study which gives one some confidence in using this is the study by Villarmosa et al (Am J Trop Med Hyg 2004 70(2): 197-200) who compared monthly ROM against MD-MDT in a group of BL and LL patients in the
I think that we should be doing larger studies to establish the role of monthly ROM in the anti-bacterial treatment of leprosy in patients with adverse effects or problems with compliance.
Diana
Diana Lockwood
Professor of Tropical Medicine
London School of Hygiene & Tropical Medicine
Keppel St
diana.lockwood(at)lshtm.ac.uk
Tel: 020 7927 2457
Fax: 020 7637 4314
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