(LML) Leprosy Post Exposure Prophylaxis

Leprosy Mailing List – July 9,  2019

Ref.:   (LML) Leprosy Post Exposure Prophylaxis

From:  Ramesh Sharma, Pokhara, Nepal

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Dear Dr Schreuder,

This is Dr. Ramesh Sharma from Greenpastures Hospital, Pokhara, Nepal. I have a few queries.

1. Nepal government has been conducting the leprosy post exposure prophylaxis (LPEP) in a few districts of Nepal. That includes providing single dose of Rifampicin to the household contacts and the close neighbourhood (about 25-30 people). Is it an effective method of chemoprophylaxis? Does it not increase the risk of Rifampicin resistance? Does it not increase the chances of having more 'persisters' and complicating the disease?

2. Our government policy is NOT to provide thalidomide to the ENL patients on an outpatient basis. Is it the same in other countries as well? Can't we provide thalidomide on an OPD basis so as to prevent the adverse effects of long-term high dose steroids...and increase patient compliance with ENL treatment. At the same time, reducing the burden to the leprosy hospitals?

Obviously, with sufficient contraception (as with other category x drugs that we regularly prescribe for dermatology patients on OPD basis... methotrexate, isotretinoin)?

3. Is there any discussion regarding substituting clofazimine with any other drug like moxifloxacin; given the stigma associated with pigmentation caused by clofazimine? Is it wise to think that clofazimine needs substitution? Do we have an effective alternative drug? Is there any research going on for this?

Thanks,

Ramesh.

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com