Leprosy Mailing List – July 13, 2024
Ref.: (LML) Single dose rifampicin prophylaxis in three Brazilian states
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
We know that Joel Almeida is very critical when it comes to Post Exposure Prophylaxis (Rifampicin) in case of leprosy. See also his LML letter of the 2nd of July 2024.
However, we like to bring some points for consideration:
1: The Brazilian data are based on routinely collected data and such data are notoriously unreliable.
2: They talk according to me about association and that is not causal (cause and effect).
3: If there would be a causal relationship, what would be the explanation?
4: Are there any animal experiments which point in that direction?
5: They have not looked for resistance. But it is known that there is Rifa resistance in that area. Antimicrobial Resistance among Leprosy Patients in Brazil: Real-World Data Based on the National Surveillance Plan. Antimicrob Agents Chemother. 2022 May 17;66(5):e0217021. doi: 10.1128/aac.02170-21. Epub 2022 Apr 18. PMID: 35435708; PMCID: PMC9112907
6. In areas where PEP has been implemented, there may be an increased awareness of leprosy and its complications.
7: If Rifampicin kills the bacillus, antigens come free and may induce a reaction which may look a relapse. This may also occur in deformed still active patients.
With regards,
Ben
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