Pediatric Leprosy Treatment & Management
- Author: Benjamin Estrada, MD; Chief Editor: Russell W Steele, MD more...
Prolonged therapeutic regimens have traditionally been recommended in the treatment of leprosy; however, recommendations by the World Health Organization (WHO) now focus on regimens with shorter duration both for tuberculoid (TT) or paucibacillary (PB) leprosy and for lepromatous (LL) or multibacillary (MB) leprosy.
The drugs that are more frequently used in the treatment of leprosy include rifampin, dapsone, clofazimine, ofloxacin, minocycline, and clarithromycin. Multidrug therapy is required in all cases to prevent antimicrobial resistance.[19, 20, 21] Any regimen must contain multiple drugs to which Mycobacteriumtuberculosis is susceptible. Guidelines for preventing the transmission of Mtuberculosis are available. In addition, the therapy must be taken regularly and continued for a sufficient period.
For MB leprosy, the standard regimen should include rifampin, dapsone, and clofazimine. For PB leprosy, rifampin is usually prescribed in combination with dapsone. For single-lesion PB leprosy, a single dose of rifampin combined with single doses of ofloxacin and minocycline is recommended. Dosages and duration of treatment for different presentations of leprosy are described elsewhere (see Medication).
An issue of medicolegal importance in the management of leprosy is related to the use of thalidomide for the treatment of erythema nodosum leprosum (ENL). Patients, male or female, who receive therapy with this drug should be made aware of its significant teratogenic complications. Thalidomide should not be prescribed to women with childbearing potential. In addition, males undergoing treatment with thalidomide must avoid sexual intercourse with women who can become pregnant.
Other Therapeutic Measures
Because of the lack of sensation associated with leprosy, patients are usually at risk for significant injury associated with trauma or burns in hypoesthetic areas. Patients should be advised to protect areas at risk of injury.
Reconstructive surgery may be indicated in patients with soft tissue defects, particularly for plantar ulcerations in patients with leprosy.
The WHO has recommended that patients undergoing treatment for leprosy should be evaluated monthly.
In addition, patients should be informed about the potential signs and symptoms of recurrences and be advised to seek medical care if any of them are observed after treatment or after the initial episode has been completed.
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