DR9.5 | Leprosy Management Under National Guidelines — Summary & Reflection

KEY TAKEAWAYS

Leprosy is curable with multidrug therapy (MDT), supplied free by the National Leprosy Eradication Programme (NLEP) in blister packs; MDT both cures the infection (the first rifampicin dose rapidly renders the patient non-infectious) and, started early, prevents the nerve damage that causes disability. Multiple drugs are combined to prevent resistance (dapsone monotherapy historically failed). The two standard regimens, chosen by WHO operational class, are: PB-MDT = rifampicin 600 mg monthly (supervised) + dapsone 100 mg daily, for 6 months (no clofazimine); and MB-MDT = rifampicin 600 mg monthly + clofazimine 300 mg monthly (supervised) + clofazimine 50 mg daily + dapsone 100 mg daily, for 12 months — and a positive smear always means MB. Doses are reduced for children. Watch for adverse effects: dapsone (haemolysis, methaemoglobinaemia, and the dapsone hypersensitivity syndrome at ~4-6 weeks — stop dapsone), rifampicin (hepatotoxicity, harmless orange secretions, enzyme-inducing interactions), and clofazimine (reversible skin pigmentation). Do not withhold MDT in pregnancy. NLEP makes leprosy notifiable, defines release from treatment, runs relapse surveillance (rising BI in MB), and adds active case detection, contact tracing, single-dose rifampicin prophylaxis, and DPMR. Prescribing the exact correct regimen is the heart of leprosy management.

REFLECT

Return to the young man and his frightened mother from the opening scenario, and the two questions every leprosy family asks — will he be cured, and will he be deformed. Reflect on how much rides on a single prescribing decision: classifying him correctly as multibacillary because of the positive smear, and giving the right three drugs for the full twelve months. Consider how easily a busy clinician might count only the patches, miss the smear's significance, and under-treat. Think too about the smaller acts of good management that protect adherence — warning a patient that rifampicin will turn his urine orange and clofazimine will darken his skin, so he does not stop the tablets in fear. As you build this competency, resolve that you will always route the treatment decision through the PB versus MB criteria, prescribe the exact regimen, and follow your patient through the programme until cure — because that discipline is what turns a curable disease into an actually-cured patient.