A patient with leprosy had slightly erythematous, anesthetic plaques on the trunk and upper limbs. He was treated with paucibacillary multidrug therapy (PB-MDT) for 6 moths. At the end of 6 months, he had persistent erythema and induration in the plaque. The next step of action recommended by the World Health Organization (WHO) in such a patient is
According to WHO treatment guidelines for Leprosy:
– All MB (multibacillary) patients who have completed 12 or more doses of WHO MDT for multibacillary leprosy ‘should be regarded as cured’ and removed from the registers.
– However, all patients should be educated about the signs and symptoms of reactions and relapse and asked to report immediately to the nearest health centre when such problems arise.
It is not necessary to give MDT to PB patients until clinical inactivity:
– Clinical activity in PB leprosy does not necessarily imply direct correlation with bacterial multiplication.
– In a large proportion of patients it is not possible to achieve clinical inactivity in six months even though all the organisms are killed: Lesions become inactive gradually over a period of one to two years after the treatment has been discontinued.
Stop antileprosy treatment
Continue PB-MDT till erythema subsides
Biopsy the lesion to document activity
Continue Dapsone alone for another 6 months