*Leprosy: Prevention and Control DOI: http://dx.doi.org/10.5772/intechopen.92089*

Duration of treatment for Multibacillary leprosy is 12 months, can be extended to 18 months and continued where possible up to smear negativity. Sometimes LL/ BL patients with high bacilli may need 2–3 years or more of MDT for achieving bacteriological negativity.

ii.Paucibacillary leprosy:

*Public Health in Developing Countries - Challenges and Opportunities*

ment of resistance and relapse, making leprosy control difficult.

The main objectives of MDT are:

1.Shorter duration of treatment,

5.Ease in health delivery system.

2.Better patient compliance,

4.Cost-effectiveness and

i.Multibacillary leprosy:

• All smear positive cases.

• Skin lesions more than five in number.

• More than one nerve trunk thickening.

Dapsone monotherapy earlier.

3.High cure rate,

• To ensure early detection of the cases.

• To interrupt the transmission of infection.

• To prevent drug resistance, relapse and reaction.

Recommended Regimens are discussed below [3, 5–7]:

MDT is recommended for following groups of patients:

The drugs used in Multibacillary MDT and dosages are:

Rifampicin: 600 mg once monthly, supervised. Dapsone: 100 mg daily, self administered.

The advantages of MDT over dapsone monotherapy are:

There are two types of MDT regimens used depending on the symptoms and signs shown by the patients - Paucibacillary (PB) and Multibacillary (MB).

• All cases of relapse/reactivation and all cases who have been treated with

Clofazimine: 300 mg once monthly, supervised and 50 mg daily, self

Since an effective vaccine is unavailable for leprosy the secondary prevention (early treatment) becomes more important. Until 1981, Dapsone (Diamino Diphenyl Sulphone—DDS) was used to treat leprosy which resulted in the develop-

Multidrug Therapy: In 1982, WHO recommended Multidrug Therapy (MDT) for all leprosy patients. Introduction of MDT has opened a new avenue in the control of leprosy in the world. Aim of MDT is to convert the infectious case into noninfectious as soon as possible, so as to reduce the reservoir of infection in the community.

**4.3 Chemotherapy**

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administered.

The drugs and dose schedule is: Rifampicin 600 mg once a month for 6 months supervised. Dapsone 100 mg daily for 6 months self administered. Paucibacillary leprosy is treated for 6 months.

MDT is not contraindicated in patients with HIV infection. Each MDT blister pack contains tablets for 4 weeks treatment. For easy identification color coding of the blister pack is done, that is, with different colors for multibacillary and paucibacillary cases both in adults and children.

The treatment in both PB and MB cases varies depending on the age of the patient. The patients between 10 to 14 years are treated as paediatric cases, while >14 years are considered adult. The standard treatment regimen for MB leprosy in adults is given for 12 months. The drugs in each blister pack are (**Figure 3**):

Two capsules of Rifampicin of 300 mg (600 mg once a month) to be taken as single dose under supervision.

Clofazimine 3 capsules of 100 mg each to be consumed once a month as single dose under supervision and 50 mg daily for next 28 days.

Dapsone 100 mg as single dose and then daily once for 1 month.

**Figure 3.** *MDT for adult MB type of leprosy [2, 7].*

The standard adult treatment regimen for PB leprosy is (**Figure 4**):

Rifampicin: 600 mg once a month. Dapsone: 100 mg daily. Duration: 6 months (6 blister packs of 28 days each). Treatment regimen for MB leprosy in children (ages 10–14 years) is (**Figure 5**):

Rifampicin: 450 mg once a month. Clofazimine: 150 mg once a month, and 50 mg every other day.

**Figure 4.** *MDT for adult PB type of leprosy [2, 7].*

**Figure 5.** *MDT for pediatric MB type of leprosy [2, 7].*

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*Leprosy: Prevention and Control*

Dapsone: 50 mg daily.

Dapsone: 50 mg daily.

**5. Surveillance**

*DOI: http://dx.doi.org/10.5772/intechopen.92089*

Rifampicin: 450 mg once a month.

coordination with national leprosy programs.

cases at least once a year for 5 years [3–5].

**6. Immunoprophylaxis**

Duration: 12 months (12 blister packs of 28 days each).

Duration: 6 months (6 blister packs of 28 days each).

Treatment regimen for PB leprosy in children (ages 10–14 years) is (**Figure 6**):

MDT is provided free-of-charge globally through an agreement between a pharmaceutical company and WHO. WHO manages distribution of MDT to countries in

Clinical surveillance of the patients after completion of treatment is an important part of MDT to ensure complete cure. For paucibacillary cases follow up for at least once a year for 2 years after completion of treatment and for multibacillary

Early diagnosis of cases, aggressive treatment and proactive measures to avoid complications and disabilities is the backbone for the success of any comprehensive program. In addition to accurate reporting and control measures, effective preventions will be needed to achieve elimination. Search for an effective vaccine either to

Presently BCG (Bacillus Calmette-Guerin) is the only vaccine that has shown some protection against *M. leprae* bacillus. A single dose of BCG gives 50 percent or higher protection against the disease. It is the most widely used vaccine in the world, yet the degree of protection it confers is not yet confirmed. The meta-analysis of many experimental studies concludes that the vaccine gives approximately 26% protection against leprosy. But the protection level decreases with time. To

a.**Adding killed** *M. leprae* **to BCG:** Various modifications have been suggested, such as the addition of killed *M. leprae* to BCG. This method almost doubles the vaccine efficacy in some populations as concluded by few studies. But the same

b.**Vaccination with** *M. indicus pranii (Mycobacterium W)*: This strain discovered in India. Testing of the MIP vaccine took place in 2005 and showed that it was effective for seven to 8 years, after which a booster dose would be needed to maintain the immunity. Recently the vaccine was approved by the Drug Controller General of India to be rolled out in a project involving five districts in the states of Bihar and Gujarat, where there are high rates of leprosy. Leprosy patients and their close contacts will benefit from this project, making India the first country in the world to have a large-scale leprosy vaccination initiative [8].

Another milestone in prevention of leprosy is the discovery of the vaccine candidate, called LepVax. Scientists at Infectious Disease Research Institute (IDRI), along with national and international collaborators including the

be used alone or in combination with a drug has been going for a long time.

overcome this problem more than one dose of vaccine is advised.

Other variants of vaccination are also suggested.

cannot be said for patients below 15 years.

**Figure 6.** *MDT for pediatric PB type of leprosy [2, 7].*

*Leprosy: Prevention and Control DOI: http://dx.doi.org/10.5772/intechopen.92089*

Dapsone: 50 mg daily. Duration: 12 months (12 blister packs of 28 days each). Treatment regimen for PB leprosy in children (ages 10–14 years) is (**Figure 6**):

Rifampicin: 450 mg once a month. Dapsone: 50 mg daily. Duration: 6 months (6 blister packs of 28 days each).

MDT is provided free-of-charge globally through an agreement between a pharmaceutical company and WHO. WHO manages distribution of MDT to countries in coordination with national leprosy programs.
