A clinical trial of minocycline in lepromatous leprosy.

Abstract

indicates that about 2540 men in the sentenced prison population injected drugs in the six months before arrest.45 If we assume from our data that 8% of them were HIV positive that gives an estimated total of 203 HIV Patients, methods, and results Eight consenting adults (seven men and one woman) with lepromatous leprosy (five patients) or borderline lepromatous leprosy (three) who had been previously untreated (six) or whose leprosy had relapsed (two) were treated with 100 mg minocycline alone once daily for three months.After one week's treatment we observed improvement in either skin erythema or induration in six patients and improvement in both manifestations in two. After three months' treatment skin lesions had noticeably improved in all patients, six patients having complete resolution of all erythema and induration. One patient had mild transient vertigo, which resolved spontaneously without discontinuing treatment. No other adverse reaction was noted. Unexpectedly, none of the patients developed a lepra reaction.Before treatment and at one week and one, two, and three months after starting treatment skin biopsies were performed, from which 5 x 103 M leprae were inoculated into the hind feet of BALB/c mice. If more than 10' acid fast bacilli per foot pad were found in pooled foot pads (four) harvested eight and 12 months subsequently or in one foot pad or more of those (generally 10) counted individually 12 months after infection, viable bacilli were considered to have been present in the inoculum.All of the pretreatment skin biopsy specimens consistently resulted in growth of the bacilli in mice when evaluated by both methods. According to the findings of pooled harvests of foot pads no patient harboured any viable M leprae at either two or three months after starting treatment (table). Harvests of individual foot pads were more sensitive in detecting any viable M leprae; in six instances these results were positive and those of pooled harvests were negative, and in none was the opposite true (table). Viable bacilli were consistently absent from the skin in only one patient at one week after treatment. At one and two months respectively three and six of the patients had lost detectable viable leprosy bacilli, and by three months none of the eight patients harboured any viable bacilli.Serum minocycline concentrations determined by an agar disc diffusion method2 were at the peak (two hours after treatment) 1 84 (SD 0 48) mg/l (range 1 07-2-66 mg/i) and at the trough (24 hours after treatment) 0-43 (0 11) mg/l (range 0 33-0 58 mg/i), well above that (0-17 mg/i) previously found to inhibit consistently growth ofM leprae in mice.23 CommentThe consistent rapidity of the patients' clinical response to minocycline is unique in our experience. The clearance of viable M leprae from the skin by minocycline was faster than that reported for dapsone or clofazimine,4 slower than that for rifampicin,' and similar to that for pefloxacin and ofloxacin.5Hansen's Disease Research Program,

Clinical trial of fusidic acid for lepromatous leprosy

“…Regarding mouse footpad infectivity, the activity of fusidic acid appears more similar to that of dapsone (20), a drug which is considered weakly bactericidal or bacteriostatic, than to the activities of more rapidly bactericidal drugs like rifampin (20), ofloxacin (16), minocycline (12), sparfloxacin (3), or clarithromycin (4). We unfortunately did not include a biopsy at 12 weeks which may have allowed a better comparison between fusidic acid and dapsone as well as between the two dosage groups.…”

Comparison of Effectiveness between Rifampicin Ofloxin-Minocycline Regimen and Multidrug Therapy-World Health Organization in Multibacillary Leprosy Patients

“…16 Based on a clinical study in rats, showed that less M. leprae live in rats who received minocycline compared to rats who received dapsone dan clofazimin. 17 Despite having a strong bactericidal property, ROM regimen also has lesser side effects compared to MDT-WHO regimen. Several studies stated that ROM regimen side effects are less common to MDT-WHO which contains dapsone and clofazimin.…”

Powerful Bactericidal Activity of Moxifloxacin in Human Leprosy

“…In the 1-year WHO (37) regimen for MB leprosy, only rifampin (29,32,34), not dapsone (32) or clofazimine (32), is bactericidal for M. leprae in patients. Though pefloxacin/ofloxacin (9,19,26), minocycline (8,12), and clarithromycin (3) clear viable M. leprae bacilli in MB patients more rapidly than dapsone or clofazimine (32), in the Philippines, they do not result in significant killing following a single dose, and each requires a few months to reliably clear all viable M. leprae bacilli (3,8,9). On the other hand, in this present study, moxifloxacin was demonstrated to consistently result in killing of M. leprae in a single dose and to clear viable bacilli within days or weeks, similar to the rate previously demonstrated only by rifampin (29,32,34).…”

“…Furthermore, in the heavily infected, neonatally thymectomized Lewis rat, the combination of rifampin and ofloxacin was more regularly sterilizing than the combinations of both rifampin plus dapsone and rifampin plus clofazimine (10), rifampin, dapsone, and clofazimine being the three components of the widely implemented WHO-recommended regimens for treatment of multibacillary (MB) leprosy (36,37). Clinical trials of pefloxacin and ofloxacin treatments in leprosy have demonstrated encouraging clinical responses and the clearance of viable M. leprae within 2 months (9,19,26), this rate of clearance being higher than those with dapsone and clofazimine (several months [32]), similar to those with minocycline (8,12) and clarithromycin (3), but much lower than that with rifampin (29,32,34).…”