Treatment

The treatment of leprosy may involve surgery, chemotherapy and physiotherapy. If a case is treated in the UK then advice from a national leprosy centre should be sought. Multi-drug therapy is now essential because of developing drug resistance - now about 20% of cases are resistant to dapsone.

The World Health Organization (WHO) recommends the same three-drug regimen for all patients with leprosy, regardless of whether they have multibacillary (MB) leprosy (≥6 lesions) or paucibacillary (PB) leprosy (1-5 lesions). MDT blister calendar packs contain rifampicin, dapsone, and clofazimine. The only difference is that patients with PB leprosy are treated for at least 6 months, while patients with MB leprosy are treated for at least 12 months. (1)

Patients who cannot take one of the first-line drugs because of adverse effects, contraindications, or intercurrent diseases can replace them with a fluoroquinolone (e.g., ofloxacin, levofloxacin, moxifloxacin), or minocycline, or clarithromycin as part of the multi-drug regimen. (2)

Leprosy is a statutorily notifiable disease. Doctors should refer all suspected or confirmed cases to one of the national leprosy centres where the case can be reviewed by a Consultant Advisor in Leprosy. 020 3447 5959 (London), 0151 706 3835 (Liverpool), 0121 424 0358 (Birmingham).

Reference

1. World Health Organization. Guidelines for the diagnosis, treatment and prevention of leprosy. Oct 2018 [internet publication].
2. Lazo-Porras M, Prutsky GJ, Barrionuevo P, et al. World Health Organization (WHO) antibiotic regimen against other regimens for the treatment of leprosy: a systematic review and meta-analysis. BMC Infect Dis. 2020 Jan 20;20(1):62.
3. Maymone MBC, Venkatesh S, Laughter M, et al. Leprosy: treatment and management of complications. J Am Acad Dermatol. 2020 Jul;83(1):17-30.