Combined therapy in principle and practice for the control of dapsone resistance

Abstract

It is essential to introduce other available anti-leprosy drugs and therapeutic regimens for the prevention of dapsone resistance. For the prevention of drug resistance in general, combined therapy has proved to be highly successful, particularly in tuberculosis. For leprosy this would involve every new lepromatous patient being treated at onset with dapsone at full dosage with at least one companion drug. For the treatment of leprosy patients with established dapsone resistance alternative drugs would be required, as combined therapy for lepromatous patients and as monotherapy for tuberculoid leprosy. While the principles for treating and controlling dapsone resistance are reasonably well worked out, it is clear that to put these into practice each country will have to very carefully consider which approach would be feasible and financially possible. It is also clear that whichever one is chosen, it must go in parallel with a greatly upgraded leprosy control service, which can only be achieved by extensive retraining of all personnel at all levels (guidelines on these requirements are set out in the 'Heathrow Report', copies of which can be obtained from LEPRA).