This is the first study reporting global data on AMR in leprosy. Rifampicin resistance emerged, stressing the need for expansion of surveillance. This is also a call for vigilance on the global use of antimicrobial agents, because ofloxacin resistance probably developed in relation to the general intake of antibiotics for other infections as it is not part of the multidrug combination used to treat leprosy.
Summaryobjective To describe the rationale, design and preliminary results of an open trial of 6 months uniform multi-drug therapy (U-MDT) for all types of leprosy patients assuming a cumulative relapse rate not exceeding 5% over 5 years of follow-up.methods We intended to recruit 2500 patients each in multi-bacillary (MB) and pauci-bacillary (PB) groups from India (five centres) and China (two centres). Standardized clinical criteria were used to assess skin lesions in the field.results A total of 2912 patients enrolled from November 2003 to May 2007 (India, 2746 China, 166). MB patients constituted 39% and 3% had grade 2 disability. During follow-up, 27 patients (0.9%) developed new lesions. Of these, 78% were on account of reactions. Six patients had clinically confirmed relapse. Clofazimine-related skin pigmentation was short-lived and was acceptable to patients. We analysed data for clinical status of skin lesions. About 2.9% of patients were lost to follow-up; 85.9% completed treatment, of whom 19% had inactive skin lesions. PB patients responded better than MB patients (27% vs. 6%; P < 0.001). At the end of the first (n = 2013) and second year (n = 807) of followup post-U-MDT, in 49% and 46% patients, lesions were inactive, respectively (59% and 57% in PB, 37% and 28% in MB; P < 0.001).conclusion U-MDT appears to be promising with respect to clinical status of skin lesions.
SummaryThe regularity with which multi bacillary patients, who were being treated with the WHO Study Group regimen in a THELEP-sponsored field trial in South India, ingested their prescribed daily clofazimine and dapsone was studied. The ingestion of clofazimine was monitored using a specially prepared fo rmulation containing minute amounts of isoniazid as an innocuous marker. Overall drug acceptability and compliance was excellent. Approximately 75% of the prescribed daily clofazimine and dapsone doses were being ingested and it was concluded that only 5% of the patients would have benefited if their treatment had been supplemented by acedapsone injections.There was however a marked correlation between the self-administration of the 2 drugs with the consequence that the patients at greatest risk of developing rifampicin resistance because of poor dapsone compliance were the very ones most unlikely to take their daily clofazimine treatment. The results obtained emphasize the importance of employing regimens containing high degrees of supervised drug administration, especially in areas where drug compliance is known to be poor.It is recommended that all multibacillary patients should be treated with a combination of rifampicin plus dapsone plus clofazimine.1 The efficiency of two such regimens is currently being evaluated in a THELEP-sponsored field trial at the Schieffelin Leprosy Research and Training Centre in Karigiri, in the North Arcot District of Tamil Nadu in South India. 2 In regimen A, supervised 600 mg doses of rifampicin and of clofazimine were given on each of 2 consecutive days once every 4 weeks. The patients were also given 100 mg tablets of dapsone for daily self administration supplemented with intramuscular injections of 225 mg diacetyldapsone (acedap sone) once every 8 weeks which release on average 3 mg dapsone daily. Regimen B was identical to that recommended by the WHO Study Group for the routine treatment of multibacillary patients, I consisting of monthly supervised doses of600 mg rifampicin and 300 mg clofazimine supplemented by daily doses of 50 mg clofazimine and 100 mg dapsone for self-administration. Treatment was to be continued for at least 2 years and until the patients became smear-negative.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.