Guideline for the treatment of Hansen's disease in Japan (Second edition)

Abstract

ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 1997). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > or = 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI become negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > or = 3, 1 year treatment by MDT/MB is necessary. When BI become negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. This is a simplification of first version in 2000. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.

Impact of Amino Acid Substitutions in B Subunit of DNA Gyrase in Mycobacterium leprae on Fluoroquinolone Resistance

“…We investigated the inhibitory effects of OFX, GAT, MXF, LVX and SIT against WT and mutant DNA gyrases. IC 50 s of OFX for WT DNA gyrase was 5.7 µg/ml ( Table 2 ) and it seemed reasonable that OFX has been used by a single application of 400 to 600 mg for leprosy patients with a single lesion and two or three doses of 400 to 600 mg in combination with first-line drugs, DDS and RIF [27] for the treatment of patients with MDR leprosy. On the contrary, IC 50 s of OFX for GyrB-Asp464Asn, Asn502Asp and Glu504Val showed 9.5, 18.7 and 6.1 fold higher concentration comparing to WT DNA gyrase, respectively, and OFX seems not to have the ability to inhibit M. leprae with DNA gyrase with these mutations.…”

Clinical analysis of multibacillary leprosy patients after 1‐year fixed World Health Organization recommended multidrug therapy at Yangon General Hospital, Myanmar

“…Therefore, BL or LL with high initial BI should be considered as a high risk of relapse. Thus in Japan, instead of 1‐year WHO‐MDT, 2–3‐year treatment by RFP, DDS and clofazimine (MDT for MB) was recommended for high bacterial load MB cases depending upon their clinical response 17 . However, a comparative study in Brazil performed on the initial and final bacillary indices of 128 MB patients who received 12 doses (MDT‐WHO) and 85 MB patients who took 24 doses of (MDT‐WHO) showed that the reduction in bacillary levels and mean bacillary indices at 24 months were similar in the two groups 18 …”