Several drugs are used in combination in multidrug therapy (MDT). (See table) These drugs must never be used alone as monotherapy for leprosy.
Dapsone, which is bacteriostatic or weakly bactericidal against M. leprae, was the mainstay treatment for leprosy for many years until widespread resistant strains appeared. Combination therapy has become essential to slow or prevent the development of resistance. Rifampicin is now combined with dapsone to treat paucibacillary leprosy. Rifampicin and clofazimine are now combined with dapsone to treat multibacillary leprosy.
A single dose of combination therapy has been used to cure single lesion paucibacillary leprosy: rifampicin (600 mg), ofloxacin (400 mg), and minocycline (100 mg). The child with a single lesion takes half the adult dose of the 3 medications.
WHO has designed blister pack medication kits for both paucibacillary leprosy and for multibacillary leprosy. Each easy-to use kit contains medication for 28 days. The blister pack medication kit for single lesion paucibacillary leprosy contains the necessary medication for the one time administration of the 3 medications.
Any patient with a positive skin smear must be treated with the MDT regimen for multibacillary leprosy. The regimen for paucibacillary leprosy should never be given to a patient with multibacillary leprosy. Therefore, if the diagnosis in a particular patient is uncertain, treat that patient with the MDT regimen for multibacillary leprosy.
Ideally, the patient should go to the leprosy clinic once a month so that clinic personnel may supervise administration of the drugs prescribed once a month. However, many countries with leprosy have poor coverage of health services and monthly supervision of drug administration by health care workers may not be possible. In these cases, it may be necessary to designate a responsible third party, such as a family member or a person in the community, to supervise the monthly drug administration. Where health care service coverage is poor and supervision of the monthly administration of drugs by health workers is not possible, the patient may be given more than the 28 days supply of multidrug therapy blister packs. This tactic helps make multidrug therapy easily available, even to those patients who live under difficult conditions or in remote areas. Patients who ask for diagnosis and treatment are often sufficiently motivated to take full responsibility for their own treatment of leprosy. In this situation, it is important to educate the patient regarding the importance of compliance with the regimen and to give the patient responsibility for taking his or her medication correctly and for reporting any untoward signs and symptoms promptly. The patient should be warned about possible lepra reactions.
