General treatment of leprosy

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It primarily affects the skin, peripheral nerves, and mucous membranes. Leprosy is the most common cause of peripheral neuritis worldwide.

Clinical presentation

Leprosy is diagnosed by the presence of one or more of the following three cardinal signs:

• Skin patch with loss of sensation.

• One or more enlarged peripheral nerves.

• Positive skin smear demonstrating Mycobacterium leprae.

Classification of leprosy

Multibacillary (MB) leprosy

Patients are classified as having multibacillary leprosy if they have:

• Six or more skin lesions, or

• A positive skin smear.

Paucibacillary (PB) leprosy

Patients are classified as having paucibacillary leprosy if they have:

• One to five skin lesions, and

• A negative skin smear.

Important note

If there is any uncertainty regarding the classification, the patient should be classified and treated as having multibacillary leprosy.

Pharmacological treatment

Leprosy should be treated using multidrug therapy (MDT). The treatment regimen depends on the classification of leprosy and the patient's age.

Multibacillary (MB) leprosy

Adults (15 years and above)

Day 1 (supervised dose):

• Rifampicin 600 mg (2 × 300 mg)

• Clofazimine 300 mg (3 × 100 mg)

• Dapsone 100 mg

Day 2–28 (daily treatment):

• Clofazimine 50 mg once daily

• Dapsone 100 mg once daily

Duration:

• 12 blister packs to be completed within 12–18 months.

Children (below 15 years)

Day 1 (supervised dose):

• Rifampicin 450 mg (3 × 150 mg)

• Clofazimine 150 mg (3 × 50 mg)

• Dapsone 50 mg

Day 2–28 (daily treatment):

• Clofazimine 50 mg every other day

• Dapsone 50 mg once daily

Duration:

• 12 blister packs to be completed within 12–18 months.

Paucibacillary (PB) leprosy

Adults (15 years and above)

Day 1 (supervised dose):

• Rifampicin 600 mg (2 × 300 mg)

• Clofazimine 300 mg (3 × 100 mg)

• Dapsone 100 mg

Day 2–28 (daily treatment):

• Clofazimine 50 mg once daily

• Dapsone 100 mg once daily

Duration:

• 6 blister packs to be completed within 6–9 months.

Children (below 15 years)

Day 1 (supervised dose):

• Rifampicin 450 mg (3 × 150 mg)

• Clofazimine 150 mg (3 × 50 mg)

• Dapsone 50 mg

Day 2–28 (daily treatment):

• Clofazimine 50 mg every other day

• Dapsone 50 mg once daily

Duration:

• 6 blister packs to be completed within 6–9 months.

Important notes

• Multidrug therapy (MDT) should be completed within the recommended treatment period to achieve cure and prevent relapse.

• When the classification of leprosy is uncertain, treatment should follow the multibacillary (MB) regimen.

• Treatment selection should be based on the patient's age and disease classification.