Once-Monthly Rifampicin Plus Daily Dapsone in Initial Treatment of Lepromatous Leprosy

Yawalkar, S J; McDougall, A C; Languillon, J; Ghosh, Sandip; Hajra, S.; Opromolla, D. V. A.; Tonello, C. J. S.

doi:10.1016/s0140-6736(82)92334-0

Cited by 28 publications

(12 citation statements)

References 4 publications

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“…Languillon, et al [24] were the first to report the efficacy and good tolerability of a single oral rifampicin dosage 1200 mg/ month schedule as a combination regimen for the treatment of LL patient. Later Yawalkar, et al [25] confirmed these findings.…”

Section: Anti -Leprosy Drugsmentioning

confidence: 82%

Leprotic Arthritis

Hamoud¹

2016

JRAD

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[7] reported a male Pakistani living in England, who was admitted to the rheumatology unit with acute widespread polyarthritis associated with fever and night sweats. Preliminary examination suggested Reiter's disease, but further investigation showed acute glomerulonephritis with uremia (blood urea, 246 mg/ 100 ml) and proteinuria leading to diagnosis of polyarteritis nodosa but muscle tenderness prompted a biopsy of gastrocnemius and skin which identified leprosy bacilli and typical lepromatous leprosy which were found also on renal biopsy.

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Section: Anti -Leprosy Drugsmentioning

confidence: 82%

Leprotic Arthritis

Hamoud¹

2016

JRAD

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“…■ Very good results were observed with the combination of dapsone and rifampicin, and there were some evidence of the equivalence of once a month rifampicin with everyday regimen [30][31][32];…”

Section: Who Multidrug Therapy: Rationale Evidence and Criticismsmentioning

confidence: 98%

“…However, mouse footpad studies from the nasal mucosa biopsy specimens did not demonstrate any growth of M. leprae [44]. Some old treatment evaluation studies used BI from nasal secretion and LBI of skin biopsies [31]. BI of skin surface and nasal secretion are end points that could be further explored in future clinical trials, as these outcomes had rarely been used in recent research.…”

Section: Measuring Bacteriological and Clinical Outcomes In Mb Leprosy mentioning

confidence: 99%

Considerations in the design of clinical trials for multibacillary leprosy treatment

Penna¹

2014

Clinical Investigation

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In 1991, the World Health Assembly adopted a resolution to attain the goal of global elimination of leprosy as a public health problem by the year 2000, based on universal access to multidrug therapy established by the WHO. The WHO multidrug therapy recommendation was not based on clinical trial results, but was based on all scientific knowledge available at the time and incorporated some financial constraints, such as the impossibility of daily rifampin use. Further decisions regarding treatment duration were needed to allow the World Health Assembly resolution target to be reached, which was set without a deep epidemiological evaluation. At present there are many uncertainties about leprosy treatment, including for instance, its ideal duration including decisions concerning daily or intermittent use of drugs, the use of immune modulators with antibacterial drugs as prophylaxis, and treatment of reactions during and after chemotherapy. To advance our knowledge of leprosy treatment, knowledge revision of the available research would be the first step to develop comprehensive Bayesian clinical trials designed to shed light on these uncertainties.

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“…When rifampicin was introduced as component of MDT treatment, a monthly dose was recommended in view of the good therapeutic efficacy and the fact that this was better tolerated than a weekly dose and the lower costs compared to daily or weekly treatment [ 52 ]. The Expert Meeting strongly advised that the enhanced regimen should also be given supervised to ensure compliance and repeatedly to increase the bactericidal effect.…”

Section: Main Textmentioning

confidence: 99%

An enhanced regimen as post-exposure chemoprophylaxis for leprosy: PEP++

et al. 2018

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The ongoing transmission of Mycobacterium (M.) leprae reflected in a very slow decline in leprosy incidence, forces us to be innovative and conduct cutting-edge research. Single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients, reduces their risk to develop leprosy by 60%. This is a promising new preventive measure that can be integrated into routine leprosy control programmes, as is being demonstrated in the Leprosy Post-Exposure Programme that is currently ongoing in eight countries.The limited (60%) effectiveness of SDR is likely due to the fact that some contacts have a preclinical infection beyond the early stages for which SDR is not sufficient to prevent the development of clinical signs and symptoms of leprosy. An enhanced regimen, more potent against a higher load of leprosy bacteria, would increase the effectiveness of this preventive measure significantly.The Netherlands Leprosy Relief (NLR) is developing a multi-country study aiming to show that breaking the chain of transmission of M. leprae is possible, evidenced by a dramatic reduction in incidence. In this study the assessment of the effectiveness of an enhanced prophylactic regimen for leprosy is an important component. To define the so called PEP++ regimen for this intervention study, NLR convened an Expert Meeting that was attended by clinical leprologists, public health experts, pharmacologists, dermatologists and microbiologists.The Expert Meeting advised on combinations of available drugs, with known efficacy against leprosy, as well as on the duration of the intake, aiming at a risk reduction of 80–90%. To come to a conclusion the Expert Meeting considered the bactericidal, sterilising and bacteriostatic activity of the potential drugs. The criteria used to determine an optimal enhanced regimen were: effectiveness, safety, acceptability, availability, affordability, feasibility and not inducing drug resistance.The Expert Meeting concluded that the enhanced regimen for the PEP++ study should comprise three standard doses of rifampicin 600 mg (weight adjusted when given to children) plus moxifloxacin 400 mg given at four-weekly intervals. For children and for adults with contraindications for moxifloxacin, moxifloxacin should be replaced by clarithromycin 300 mg (weight adjusted).

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Once-Monthly Rifampicin Plus Daily Dapsone in Initial Treatment of Lepromatous Leprosy

Cited by 28 publications

References 4 publications

Leprotic Arthritis

Leprotic Arthritis

Considerations in the design of clinical trials for multibacillary leprosy treatment

An enhanced regimen as post-exposure chemoprophylaxis for leprosy: PEP++

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