Leprosy Medication

  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jul 6, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to prevent complications, and to reduce morbidity.

The multidrug therapy plan recommended by the WHO can be used to plan therapy based on the type of leprosy (paucibacillary or multibacillary) and whether it is supervised monthly or self-administered daily (see Medical Care).

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Antimycobacterial Agents

Class Summary

These agents have bactericidal and bacteriostatic activity against mycobacteria.

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Dapsone (Avlosulfon)

 

Bactericidal and bacteriostatic against mycobacteria; mechanism of action is similar to that of sulfonamides, in which competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth. Part of a 2-drug regimen for treatment of paucibacillary leprosy; part of a 3-drug regimen for treatment of multibacillary leprosy.

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Rifampin (Rifadin, Rimactane)

 

For use in combination with at least 1 other antituberculous drug; inhibits DNA-dependent bacterial but not mammalian RNA polymerase. Most bactericidal drug used against M leprae. Cross-resistance may occur.

Treat for 6-9 mo or until 6 mo have elapsed from conversion to sputum-culture negativity.

Part of 2-drug regimen for treatment of paucibacillary leprosy; part of 3-drug regimen for treatment of multibacillary leprosy.

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Clofazimine (Lamprene)

 

Inhibits mycobacterial growth, binds preferentially to mycobacterial DNA. Has antimicrobial properties, but mechanism of action is unknown. Part of 3-drug regimen for treatment of multibacillary leprosy.

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Minocycline

 

Used to treat leprosy in patients who cannot tolerate clofazimine.

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Contributor Information and Disclosures
Author

Darvin Scott Smith, MD, MSc, DTM&H  Adjunct Assistant Professor, Department of Microbiology and Immunology, Stanford University School of Medicine; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital

Darvin Scott Smith, MD, MSc, DTM&H is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Tara Ramachandra  Stanford University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Fred A Lopez, MD  Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine

Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, and Louisiana State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Baxter International and Johnson & Johnson Royalty Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. World Health Organization. Global leprosy situation, 2005. Wkly Epidemiol Rec. Aug 26 2005;80(34):289-95. [Medline].

  2. Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL. The continuing challenges of leprosy. Clin Microbiol Rev. Apr 2006;19(2):338-81. [Medline]. [Full Text].

  3. Joyce MP, Scollard DM. Leprosy (Hansen's Disease). Conn's Current Therapy. 2004;100-105.

  4. Truman RW, Singh P, Sharma R, et al. Probable zoonotic leprosy in the southern United States. N Engl J Med. Apr 28 2011;364(17):1626-33. [Medline].

  5. Ustianowski AP, Lockwood DN. Leprosy: current diagnostic and treatment approaches. Curr Opin Infect Dis. Oct 2003;16(5):421-7. [Medline].

  6. Anderson GA. The surgical management of deformities of the hand in leprosy. J Bone Joint Surg Br. Mar 2006;88(3):290-4. [Medline].

  7. Walker SL, Lockwood DN. Leprosy. Clin Dermatol. Mar-Apr 2007;25(2):165-72. [Medline].

  8. Anderson H, Stryjewska B, Boyanton BL, et al. Hansen disease in the United States in the 21st century: a review of the literature. Arch Pathol Lab Med. Jun 2007;131(6):982-6. [Medline].

  9. [Best Evidence] Van Veen NH, Nicholls PG, Smith WC, Richardus JH. Corticosteroids for treating nerve damage in leprosy. Cochrane Database Syst Rev. Apr 18 2007;CD005491. [Medline].

  10. Kai M, Nguyen Phuc NH, et al. Analysis of Drug-Resistant Strains of Mycobacterium leprae in an Endemic Area of Vietnam. Clin Infect Dis. Mar 2011;52(5):e127-32.

  11. Singh P, Busso P, Paniz-Mondolfi A, et al. Molecular Drug Susceptibility Testing and Genotyping of Mycobacterium leprae Strains from South America. Antimicrob Agents Chemother. Jun 2011;55(6):2971-3. [Medline]. [Full Text].

  12. Bakker MI, Hatta M, Kwenang A, et al. Risk factors for developing leprosy--a population-based cohort study in Indonesia. Lepr Rev. Mar 2006;77(1):48-61. [Medline].

  13. Britton WJ, Lockwood DN. Leprosy. Lancet. Apr 10 2004;363(9416):1209-19. [Medline].

  14. Deps PD, Guedes BV, Bucker Filho J, Andreatta MK, Marcari RS, Rodrigues LC. Characteristics of known leprosy contact in a high endemic area in Brazil. Lepr Rev. Mar 2006;77(1):34-40. [Medline].

  15. Jacobson RR, Krahenbuhl JL, Yoder L. Overview of Leprosy. UpToDate. 2006.

  16. Leprosy. World Health Organization. Available at www.who.org.

  17. Moschella SL. An update on the diagnosis and treatment of leprosy. J Am Acad Dermatol. Sep 2004;51(3):417-26. [Medline].

  18. Rao PS, Sugamaran DS, Richard J, et al. Multi-centre, double blind, randomized trial of three steroid regimens in the treatment of type-1 reactions in leprosy. Lepr Rev. Mar 2006;77(1):25-33. [Medline].

  19. Sridharan R, Lorenzo N, Narasimhan L. Leprosy. eMedicine. 2005.

  20. van Beers SM, Hatta M, Klatser PR. Patient contact is the major determinant in incident leprosy: implications for future control. Int J Lepr Other Mycobact Dis. Jun 1999;67(2):119-28. [Medline].

 
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Hands with Z-thumbs, clawing, contractures, and shortening of fingers due to repetitive injury and healing. Ho Chi Minh City, Vietnam. (Courtesy of D. Scott Smith, MD)
Patient with facial nerve palsy and contractures of the hand. Daloa, Ivory Coast. (Courtesy of D. Scott Smith, MD)
Chronic insensate patch due to leprosy infection. Ho Chi Minh City, Vietnam. (Courtesy of D. Scott Smith, MD)
Characteristic clawed hand deformity caused by ulnar involvement in leprosy. Daloa, Ivory Coast. (Courtesy of D. Scott Smith, MD)
Chronic nonhealing ulcer at the metatarsal head resulting from loss of sensation in the feet. Karigiri, Tamil Nadu, India. (Courtesy of Tara Ramachandra)
Multiple flat hypopigmented lesions on shoulder and neck, suggestive of multibacillary leprosy. Note ulceration of hypothenar area of hand, indicative of ulnar neuropathy. Redwood City, California, United States. (Courtesy of D. Scott Smith, MD)
Man with advanced deformities caused by unmanaged leprosy. Keratitis, loss of eyebrow, thickened skin, and typical hand impairments. Ho Chi Minh City, Vietnam. (Courtesy of D. Scott Smith, MD)
Histopathology of leprosy: Large numbers of acid-fast bacilli (in clusters) in histiocytes and within nerves. Fite-Faraco stain 500 X. (Courtesy of Tara Ramachandra and D. Scott Smith, MD)
Patient with multibacillary leprosy showing subsequent erythema nodosum leprosum reaction. Santa Clara, California. (Courtesy of D. Scott Smith, MD)
Patient with erythema nodosum leprosum type 2 reaction several weeks after initiation of drug therapy. This photograph was taken after tendon release. Redwood City, California. (Courtesy of D. Scott Smith, MD)
Increased pigmentation on the face due to clofazimine therapy. (Courtesy of D. Scott Smith, MD)
Table. Multidrug Therapy Plan Recommended by the WHO
Type of LeprosyDaily, Self-AdministeredMonthly SupervisedMonths of Treatment
PaucibacillaryDapsone 100 mgRifampicin 600 mg6-12
MultibacillaryDapsone 100 mg,



Clofazimine 50 mg



Rifampicin 600 mg,



Clofazimine 300 mg



24
PediatricDapsone 2 mg/kg,



Clofazimine 1 mg/kg



Rifampicin 10 mg/kg,



Clofazimine 6 mg/kg



Same as in adults
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