Health Significance Of The Management And The General Treatment Plan Of Leprosy

Funom Makama By Funom Makama, 21st Mar 2014 | Follow this author | RSS Feed | Short URL http://nut.bz/28zmxegl/
Posted in Wikinut>Health>General Health>Diseases & Infections

The clinical diagnosis of leprosy should always be confirmed by the laboratory tests, before starting treatment, in view of the socio-economic and psychological implications. Education of the patient on the nature of the disease, outcome of treatment, and measures to avoid spread are absolutely essential for success.

General Treatment

This includes measures to improve general health and treatment of intercurrent illness

Chemotherapy: The basic treatment is the administration of the drug dapsone. It is bacteriostatic and is very effective when taken orally in a dose of 6 to 10 mg/Kg wt per week. The drug is given once a day, an average adult dose is 100 mg/day. Side effects are quite few. Anemia, dermatitis, hepatitis, psychosis and blood dyscrasias are rarely seen. The drug is cumulative in the system.

The full dose should be given from the start of therapy and continued throughout. With this dosage, it is unlikely to develop drug resistance, though reports of resistance are appearing, especially in lepromatous leprosy. Though most of the patients are rendered non-infectious within a few weeks, clinical improvement may not be apparent for several months. Complete resolution may take many years.

In tuberculoid leprosy, which shows a great tendency to heal spontaneously, a smaller dose of dapsone (50 mg daily) is adequate if given for 3 years. In borderline leprosy, in which adverse drug reactions are common, careful supervision of the dose and follow up are necessary. In these cases, dapsone is started in doses of 50 to 100 mg per day depending on whether the patient is near the tuberculoid or lepromatous end of the spectrum. Treatment is given till all signs of activity of the disease have subsided and then for a further period of 10 years.

The Newer Drugs

Availability of drugs such as rifampicin and clofazamine has made it possible to devise new therapeutic schedules which are very effective and of shorter duration. Rifampicin is powerfully bactericidal when given in a dose of 450 to 600 mg/day and it is capable of rapidly killing M. leprae even with a short exposure. Clofazamine is bacteriostatic when given in a dose of 100 mg a day. It has also got inflammatory properties. For purposes of treatment, the cases are divided into paucibacillary (smear negative for M. leprae) and multibacillary (smear positive for M. leprae) types.

Paucibacillary Cases: Rifampicin 600 mg once a month (supervised) and Dapsone 100mg/daily. This treatment is continued for a minimum period of six months or till all signs of activity of the disease are cleared- whichever is longer.

Multibacillary cases: For the initial 14 days, give the following supervised: Rifampicin 600mg/day, clofazamine, 100mg/day and Dapsone, 100 mg/day. Then for subsequent treatment, administer Clofazamine 100mg on alternate days or 50mg/daily. Also give Dapsone 100 mg daily and in addition, a cocktail consisting of rifampicin 600 mg, clofazamine, 300mg and dapsone 100 mg is given once a month under supervision. This regimen is continued till the smear becomes negative but is no case less than 2 years. If dapsone resistance is suspected, the following regimen is given.

Paucibacillar type includes Rafampicin 600 mg once a month + Clofazamine 100 mg/day. Mutibacillary type includes Prothionamide or Ethionamide in a dose of 375 mg instead of dapson.

Side effects of clofazamine include abdominal discomfort and pain reddish brown pigmentation of the skin and staining of all secretions.

Treatment Of Reactions

In type I reaction, the specific anti-leprosy drug like dapsone is continued unchanged unless there are compelling reasons to discontinue it. In mild reactions, the pain and tenderness in skin lesions and nerves are relieved by aspirin, chloroquine or stibophen. More severe reactions necessitate the use of corticosteroids, especially to prevent nerve damage. Clofazamine is a valuable drug in reaction since it is both antibaciliary and anti-inflammatory. The anti-inflammatory action is slow in oset, manifesting only after 4 to 6 weeks. To control acute reactions, clofazamine should be started along with corticosteroids. When given as a drug for reaction, clofazamine should be given in higher dose of 100 to 300 mg daily.

Type 2 reaction responds well to thalidomide in a dose of 100 mg three to four times a day. Other anti-inflammatory agents used for the treatment of type 1 reaction may also be used. Impending nerve damage, severe skin ulceration or marked inflammatory changes in organs like testes or eyes are indications for systemic corticosteroids. In general, corticosteroids should be avoided in lepromatous leprosy.

Other measures: Splinting and physiotherapy help to prevent nerve damage and its sequelae. Care of hands and feet, protective footwear, physiotherapy and rehabilitation are integral parts of patient care in subjects with sensory loss.

You can view other significant health related articles by clicking on any of these links below
1. Pathogenesis And Clinical Presentation Of Hemolytic Disease Of The New Born
2. Special Types Of Anemia: Sideroblastic Anemias And Paroxysmal Nocturnal Hemoglobinuria (PNH)
3. Diseases Of The Myocardium II: Cardiomyopathy
4. Inherited Disorders Of The Erythrocytes: Hereditary Spherocytosis As A Red Cell Membrane Disorder

moderator Steve Kinsman moderated this page.
If you have any complaints about this content, please let us know

Comments

Add a comment
Username
Can't login?
Password