Leprosy Mailing List – June 8, 2015
Ref.: (LML) Alternative MDT drugs and treatment duration
From: Annick Mondjo, Libreville, Gabon
Dear Dr. Schreuder,
My answer is for Dr. Warren topic (LML, May 29, 2015)
I agree with Dr Tarung Narang : “If the patient has received 1-2 years of MDT and his BI has decreased from 5 to 2 then he has responded well to treatment”. For IB cannot decrease more than one (1) log a year, it is normal to observe a positive IB at the end of a standard OMS MB PCT protocol (of one year) and even after two years. IB 6+ patients can be “cured” by standard PCT, even if relapse are quite more frequent when initial IB is 4+ and upper.
I would suggest to “stop the treatment and observe” the patient, by the least once a year. Bacteriological exams should be renewed too at this occasion, and I would suggest to consider the IM value (morphologic index) at the same time as the IB, in order to monitor the percentage of viability of the bacilli and not only their number. On the other hand, if PCR is available, isn’t it possible to check the sensitivity of the Mycobacterium to drugs, particularly to Rifampicin, in order to detect an early relapse or a primary resistance.
Best regards,
Annick MONDJO, M.D.
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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