Leprosy Mailing List – June 7, 2019
Ref.: (LML) Recurrence rate among MB patients following RFT
From: Richard Frankel, Honolulu, USA
Dear Dr. Schreuder,
This comment is prompted by Dr. Almeida's posting but applies to many comments over the past year or so regarding the inadequacy of 2 years of WHO MDT for many LL patients, particularly those with an initial high BI.
I completely agree that most if not all of these patients need additional treatment but am concerned about the drugs that are usually advocated. While they may be the best that we have for killing M. leprae and M. lepromatosis, I urge caution in prescribing Moxifloxacin and Minocycline to a large number of patients without, at a minimum, ensuring that there is a dependable system to monitor those patients for adverse effects.
With regard to Moxifloxacin, a fluoroquinolone antimicrobial agent, this group of drugs has been recognized in recent years as being responsible for a wide variety of potentially severe adverse effects. Among serious side effects noted and the subject of warnings by the U.S. Food and Drug Administration are tendinitis and tendon rupture, worsening of myasthenia gravis, irreversible peripheral neuropathy, a variety of central nervous system effects including disturbances in attention, disorientation, memory impairment and others, hypoglycaemic coma, and rupture or tear of the aorta. I am not arguing that they should never be used for multibacillary leprosy but am concerned that using them as part of a protocol where careful instruction and follow-up are not included may lead to catastrophic consequences for some patients.
Minocycline is a different matter. Though generally a well tolerated drug, it frequently causes dizziness, nausea, and vertigo. This is more likely to occur in smaller patients. While the side effects of minocycline disappear after the drug is discontinued, if the patient associates them with the drug, they may lose confidence in their treatment and drop out of care.
Thank you for posting this statement of my opinion.
Sincerely,
Richard I. Frankel, M.D., M.P.H.
Emeritus Professor of Medicine
University of Hawai'i John A. Burns School of Medicine
Honolulu, Hawaii
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
No comments:
Post a Comment