Multibacillary leprosy is treated by
Ans C (Rifampicin +dap......) Ref Handbook of leprosy Jopling Pill, Ref: Park p.267Chemotherapy for leprosy- WHO recommendations:MULTIBACILLARY LEPROSY12 months to be completed within 18 months*Rifampicin- 600mg once monthly under supervision*Clofazimine- 300 mg once monthly under supervision - 50 mg daily self administered*Dapsone-100 - mg daily self administeredPAUCIBACILLLARY LEPROSY6 months to be completed within 9 months*Rifampicin 600mg once monthly supervised* Dapsone 100 mg daily self administered.PAUCIBACILLARY LEPROSY SINGLE LESION (Single dose)Ofloxacin 400 mg, Rifampicin 600 mg,Minocycline 100 mgLeprosy is a highly infectious disease of low pathogenicity. It is effectively made non-infectious by treatment with rifampicin for 3 weeks ( KERALA 2007)and by dapsone for 90 days. Local application of rifampicin (drops or spray) may destroy all the bacilli within 8 days.Anti-leprotic drugsRIFAMPICINIt is bactericidal to M.leprae and rapidly renders leprosy patients noncontagious. Up to 99.99% M.leprae are killed in 3-7 days.MOA-Rifampicin binds to the beta subunit of bacterial DNA-dependent RNA polymerase and thereby inhibits RNA synthesisOther indications include tuberculosis, prophylaxis of meningococcal and H.influenza meningitis and carrier state,combined with doxycycline in brucellosis, 2nU/3rd choice drug in MRSA,diphtheroids and legionella.Adverse effectsImparts a harmless orange color to urine, sweat, tears, and contact lenses .Rashes, thrombocytopenia, and nephritis.Cholestatic jaundice and occasionally hepatitis.Rifampin commonly causes light-chain proteinuria.If administered less often than twice weekly, rifampicin causes a flu-like syndrome characterized by fever, chills, myalgias, anemia, and thrombocytopenia and sometimes is associated with acute tubular necrosis. Rifampin strongly induces most cytochrome P-450 isoforms.DAPSONE (DDS)-Dapsone (diaminodiphenylsulfone).Like the sulfonamides, inhibits folate synthesis. It is leprostatic at low concentrations, and at relatively higher concentrations arrests the growth of many other bacteria sensitive to sulfonamides.Other uses1) In combination with pyrimethamine, dapsone is used for treatment of chloroquine-resistant malaria.2) It is used to prevent and treat Pneumocystis jirovecipneumonia in AIDS patients.Adverse effectsMany patients develop some hemolysis, particularly if they have glucose-6-phosphate dehydrogenase deficiency.Methemoglobinemia is common..Gastrointestinal intolerance, fever, pruritus, and various rashes also occur.Allergic rashes, fixed drug eruption, hypermelanosis, phototoxicity, and exfoliative dermatitis are the various cutaneous reactions seen.CLOFAZIMINEIt is a dye with leprostatic and anti-inflammatory properties.Its MOA is unknown but may involve DNA binding.Adverse effectsSkin-The most prominent untoward effect is skin discoloration ranging from red-brown to nearly black.Dryness of skin and itching is also seenAcneform eruptions and photoxicity have been notedGIT-Gastrointestinal intolerance occurs occasionally.Other antibiotics used are ofloxacin, minocycline and clarithromycin.
Dapsone alone
Dapsone and rifampicin
Rifampicin +dapsone+cIofazimie
Rifampicin +clofazimine
Bacterial Infection of Skin