Treatment
Today,
a multi-drug approach is utilized to treat leprosy, with a high success rate
for cure. However, patient compliance is essential, and treatment can be
extremely long; 12-24 months. (In 1997, the World Health Organization reduced
the duration of therapy for multibacillary leprosy to
12 months; however, in the United States, treatment continues to be done for 24
months for severe cases.)To date, there have been no reports of anti-microbial
resistance to multi-drug therapy (MDT), much to the relief of the World Health
Organization (WHO). The WHO provides MDT in blister packs, freely available
throughout the world, thanks in part to partnerships with pharmaceutical
companies like Novartis. The blister packs provide an
easy to transport and use format for the patient.
Right :
Different blister packs are given to different types of leprosy patients. For
less severe paucibacillary patients, only two
antibiotics are used. For the more serious multibacillary
patient, a three antibiotics are used as part of the
treatment regimen.
Photo
Credit: World Health Organization
Specific Drug Information
Note: The following
information does not replace the advice of your medical doctor.
Dapsone
(4,4’
–diaminodiphenysulfone, DDS)
Created in the early 20th
century by German chemists, this drug was only utilized in the fight against
leprosy in the late 1940s. A popular leprosy drug due to its efficaciousness
and inexpensive cost, clinicians quickly became concerned about its use when
used alone. Since the 1980s, the World Health Organization has recommended that
Dapsone must be used in conjunction with other
antibiotics.
Mode of action: Appears to
be a competitive inhibitor preventing the synthesis of dihydropfolic
acid (Jacobson 196).
Side effects: In particular,
“DDS/Sulfone syndrome” is well documented,
starting 6 weeks after dapsone treatment begins.
Severe symptoms include exfoliative dermatitis and
hepatitis.
Rifampin
(Also known as: rifampicin)
One of the second-generation
leprosy drugs discovered after Dapsone, monotherapy (i.e. using the antibiotic alone) with this
drug can also lead to antibiotic resistance. Most clinicians feel that rifampin should be administered under supervision, to
ensure proper compliance in addition to the monitoring of toxic side effects. Rigampin’s bactericidal activity is the most rapid of the
three listed here.
Mode of action: Interferes
with bacterial RNA synthesis (Jacobson 199).
Side effects: Most commonly,
hepatotoxicity (toxicity in the liver); “flu like”
symptoms.
Clofazimine
(Also known as Lamprene)
Initially developed as a
drug for tuberculosis, it became an accepted agent for MDT therapy for the multibacillary leprosy patient. Resistance to the drug during monotherapy is possible (Jacobson 201).
Mode of action: Binds to the
DNA of the leprosy bacterium (Gladwin 136).
Side effects: Discoloration
of the skin into a reddish/purplish-black skin tone but usually clears several
months after treatment is stopped. Discoloration is expected during treatment
of active disease (Jacobson 201). Gastrointestinal complaints have also been
noted.
Leprosy Reactions
Hypersensitivity to the
dying or dead leprosy bacteria can result in marked reactions that may
complicate MDT therapy. MDT therapy should not be stopped despite the
reactions. Instead, these reactions should be treated with corticosteroids
(e.g. prednisone), which reduces the body’s hypersensitivity.
A Type 1 Reaction, or
reversal reaction, occurs within 1 year of treatment; symptoms include a marked
swelling of lesions as well as possible nerve function loss.
A Type 2 Reaction, or Erythema Nodosum Leprosum, is associated with an outbreak of a painful,
nodular rash. The highly publicized drug, thalidomide, known for causing birth
defects, has been advocated for the treatment of this reaction.
Preventive Therapy
The patient must also engage
in protective measures to prevent inadvertent injury, trauma or infection in
areas with anesthesia. Close monitoring of limbs, good hygiene and the use of
protective eyewear and eye-drops can significantly prevent the morbidity
associated with leprosy.
Reconstructive Surgery
The cosmetic effects of leprosy can be devastating.
As noted by the earliest clinicians, leprosy can turn a young man into having
an appearance of “an evil wrinkled old man” (Richards 105). While physical
therapy and special apparatus can be applied to the patient’s limbs to help
with the “clawing” of hands and feet, reconstructive surgery can result in a
marked improvement in quality of life and social acceptance. Grafts for
eyebrows, nasal reconstruction and face-lifts can reduce the patient’s
saddle-nose deformity or lion-like appearance. Peace of mind through the
therapy can be most helpful for the patient’s recovery (Brand).
Right : Before
and After picture of a leprosy patient who underwent nasal reconstruction, and
eye-brow graft and face-lift.
Photo
Credit: Paul W. Brand. Rehabilitation in Leprosy. Leprosy. 1983