Medication Summary
The goals of pharmacotherapy are to eliminate the infection, to prevent complications, to halt its further transmission and spread, and to reduce morbidity.
The multidrug therapy (MDT) 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).
Clofazimine is no longer commercially available in the United States. It is available only by obtaining an investigational new drug (IND) permit from the National Hansen’s Disease Program (NHDP) from the U.S. Department of Health and Human Services. For more information, visit www.hrsa.gov/hansensdisease/ or call 1-800-642-2477.
Antibiotics, Other
Class Summary
These agents have bactericidal and bacteriostatic activity against mycobacteria.
Dapsone
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.
Rifampin (Rifadin)
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.
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. No longer commercially available in the United States; available only by obtaining an investigational new drug (IND) permit from the National Hansen's Disease (Leprosy) Program (NHDP).
Minocycline (Minocin, Solodyn)
Minocycline is a semisynthetic tetracycline. Has bacteriostatic activity. Inhibits protein synthesis, and is selectively concentrated in susceptible organisms. It is used in single-lesion paucibacillary leprosy in patients who cannot tolerate clofazimine.
Ofloxacin (Floxin)
Ofloxacin is a pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. It is used in single-lesion paucibacillary leprosy.
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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.
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Patient with facial nerve palsy and contractures of the hand. Daloa, Ivory Coast. Courtesy of D. Scott Smith, MD.
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Chronic insensate patch due to leprosy infection. Ho Chi Minh City, Vietnam. Courtesy of D. Scott Smith, MD.
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Characteristic clawed hand deformity caused by ulnar involvement in leprosy. Daloa, Ivory Coast. Courtesy of D. Scott Smith, MD.
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Chronic nonhealing ulcer at the metatarsal head resulting from loss of sensation in the feet. Karigiri, Tamil Nadu, India. Courtesy of Tara Ramachandra.
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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.
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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.
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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.
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Patient with multibacillary leprosy showing subsequent erythema nodosum leprosum reaction. Santa Clara, California. Courtesy of D. Scott Smith, MD.
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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.
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Increased pigmentation on the face due to clofazimine therapy. Courtesy of D. Scott Smith, MD.
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WHO Multidrug Therapy Regimens. Courtesy of WHO, Leprosy Elimination, http://www.who.int/lep/mdt/en/, accessed April 15, 2016.
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Leprosy prevalence rates, 2014. Courtesy of WHO, Leprosy: Global situation, http://www.who.int/lep/situation/en/, accessed April 28, 2016.
Tables
Type of Leprosy |
Daily, Self-Administered |
Monthly Supervised |
Months of Treatment |
Paucibacillary |
Dapsone 100 mg |
Rifampicin 600 mg |
6 |
| Single-lesion paucibacillary | Rifampicin 600 mg, Ofloxacin 400 mg, Minocycline 100 mg |
N/A | Single dose |
Multibacillary |
Dapsone 100 mg, Clofazimine 50 mg |
Rifampicin 600 mg, Clofazimine 300 mg |
12 |
Pediatric |
Dapsone 2 mg/kg, Clofazimine 1 mg/kg |
Rifampicin 10 mg/kg, Clofazimine 6 mg/kg |
Same as in adults |
| Type of Leprosy | Daily, Self-Administered | Monthly Supervised | Months of Treatment |
| Paucibacillary | Dapsone 100 mg, Rifampicin 600 mg |
N/A | 12 |
| Single-lesion paucibacillary | Dapsone 100 mg, Rifampicin 600 mg |
N/A | 12 |
| Multibacillary | Dapsone 100 mg, Rifampicin 600 mg, Clofazimine 50 mg |
N/A | 24 |
