Short-course multidrug therapy for leprosy patients in Western Kenya. Preliminary communication

Abstract

A prospective study has been undertaken to evaluate how tolerable and effective short-course multidrug chemotherapeutic regimens are, for both multibacillary and paucibacillary cases of leprosy, using WHO-recommended regimens. For paucibacillary cases, we have compared the WHO recommended multidrug regimen and a modified multidrug regimen, consisting of rifampicin 1500 mg at the outset and repeated after 3 months, together with dapsone 100 mg daily unsupervised. The WHO recommended multidrug regimen for multibacillary cases of leprosy is given for 2 years, after which cases are followed for 3 years. Paucibacillary cases on WHO-recommended and modified MDT will get active therapy for 6 months after which they will be followed for 18 months. A total of 145 patients were admitted to the study, out of which 37 (25.5%) were multibacillary and 108 (75.5%) paucibacillary cases. Of the registered cases 93 (64.1%) are females and 52 (35.9%) are males. Within the period of study, a quite high clinical cure rate was noted amongst paucibacillary cases, in many instances from the second month onwards. The default rate was low and no adverse effects associated with the use of either clofazimine or rifampicin were noted. One female patient developed exfoliative dermatitis, thought to be due to dapsone, which completely cleared once the use of this drug had been stopped, and another female patient had hypochromic anaemia, calling for transfusion, also possibly related to dapsone. Contrary to reports from some other centres on continuing activity in paucibacillary cases even after the full course of WHO-recommended therapy, our preliminary experience in Kenya suggests that clinical cure can be achieved in much shorter periods than had hitherto been supposed.