Leprosy Mailing List – December 7 , 2020
Ref.: (LML) Replacing opinions with research
From: Ajit P, Maharashtra, India
Dear Pieter,
The relapse rate from WHO MDT (even a two year regimen ) is NOT low. Ample number of references can be found in:
Gelber RH, Grosset J. The chemotherapy of leprosy: an interpretive history. Lepr Rev. 2012 Sep;83(3):221-40. PMID: 23356023.
This is a must read article for any leprologist.
In my clinical experience, for any highly bacillated leprosy patient with BI greater than 4, RELAPSE following WHO MDT of 1 year is a MATHEMATICAL CERTAINTY. This may not be corroborated by all the available evidence, however this my clinical impression.
Time and again Dr Joel Almeida has been very correctly pointing out that we need longer and more intensive therapy for lepromatous cases.
I had once shared the example of Procrustean bed on this forum
http://leprosymailinglist.blogspot.com/2019/05/lml-beware-of-procrustean-bed.html?m=1
emphasizing that all leprosy patients are not alike and highly bacillated patients suffer due to the 'one size fits all' strategy .
We need to extensively study newer regimens like combination of multiple cidal agents (rifampicin, moxifloxacin, minocycline, clarithromycin, ofloxacin) for better treating highly bacillated leprosy patients.
Thanks.
Dr Ajit.
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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