 Leprosy, caused by mycobacterium leprae, has been considered incurable since ages and bears a social stigma.  Due to availability of effective antileprotic drugs now, it is entirely curable, but deformities already incurred may not reverse.

1. Sulfone  Dapsone 2. Phenazine Derivatives  Clofazimine 3. Antitubercular Drugs  Rifampin  Ethionamide

4. Other Antibiotics  Ofloxacin  Minocycline  Clarithromycin

 It is diamino diphenyl sulfone (DDS), the simplest, oldest, cheapest, most active and most commonly used member of it is class.  All other sulfones are converted in the body to DDS, many have been used, but none is superior.  It is available in 25, 50, 100mg tabs.

 Inhibition of PABA incorporation into folic acid.  It is antibacterial action is antagonized by PABA.  It is leprostatic at low concentrations, and at relatively higher concentrations arrests the growth of many other bacteria sensitive to sulfonamides.

 Dapsone resistance among M. Leprae, first noted in 1964, has spread and has necessitated the use of multi-drug therapy (MDT).

 Dapsone is completely absorbed after oral administration and is widely distributed in the body.  Dapsone is more concentrated in the skin, muscle, liver and in the kidney.  Metabolites are excreted in bile and reabsorbed from the intestine.  The plasma half life of dapsone is variable.  Elimination takes 1-2 weeks longer.

 Leprosy  Chloroquine resistant malaria (in combination with Pyrimethamine)  Other bacteria's who are sensitive to sulfonamides.

 Mild haemolytic anemia  Nausea  Anorexia  Headache  Fever  Mental symptoms  Allergic rashes  Photo toxicity  Hepatitis

 Hypersensitivity  Sever anemia (less than 7 Hb)  G6PD

 It is a dye with leprostatic and anti- inflammatory properties, acts probably by interfering with template function of DNA in M. Leprae.  When used alone, resistance to clofazimine develops in 1-3 years.  Clofazimine is orally active (40-70% absorbed).

 The half life of Clofazimine is 70 days, so that intermittent therapy is possible.  Clofazimine is used as component of multi- drug therapy of leprosy.  Because of it is anti-inflammatory property, it is valuable in lepra reactions.  Occasionally, it is used as a component of MDT.

 Clofazimine is available in 50, 100mg capsules for different brand names like clofozine, hansepran.

 Reddish black discoloration of skin.  Discoloration of hair  Dryness and itching of skin  Acne  Photo toxicity  Conjuctival pigmentation

 Loose stool  Nausea  Abdominal pain  Anorexia  Weight loss

 Clofazimine is to be avoided during early pregnancy and in patients with liver or kidney damage.

 It is important antitubercular drug and bactericidal to M. Leprae.  Upto % M. Leprae are killed in 3-7 days, however it is not satisfactory if used alone, some bacilli persist even after prolonged treatment- resistance develops.  It has been included in the multi drug therapy of leprosy.

 The 600mg monthly dose used in leprosy is relatively non-toxic and does not induce metabolism of other drugs.  It should not be given to patients with hepatic or renal dysfunction.

 Ethionamide is a antitubercular drug that has significant antileprotic activity, but causes Hepatotoxicity in 10% patients.  It has been used as an alternative to Clofazimine but other substitutes are preferred.  It should be used 250mg per day only when absolutely necessary.

 Ofloxacin  Pefloxacin  Gatifloxacin  Sparfloxacin  Minocycline  Clarithromycin

 Many trials have evaluated ofloxacin as a component of MDT and found it to hasten the bacteriological and clinical response.  Over 99.9% bacilli were found to be killed by 22 daily doses of ofloxacin monotherapy.  It is used in case of rifampin cannot used or to shorten the duration of treatment.  Dose: 400mg per day.

 Minocycline has high lipophilicity and active against M. Leprae. A dose 100mg per day produces peak blood levels that exceed maximum concentration.  It is antibacterial activity is less than the rifampin.  It is included multiple Drug Therapy.

 Leprosy is a chronic granulomatous infection caused by mycobacterium Leprae, primarily affecting skin, mucous membrane and nerves.  It is more prevalent among the lowest socio- economic strata.  Many patients exploit it for begging and donot come forward for treatment.

 Two polar types- lepromatous (LL), and tuberculoid (TT) with four intermediate forms- borderline (BB), borderline lepromatous (BL), borderline tuberculoid (BT) and indeterminate (I) of the disease are recognized.

 For operational purposes, leprosy has been divided into: 1. Paucibacillary leprosy (PBL): Non- infectious, this includes TT, BT, I. 2. Multibacillary leprosy (MBL): infectious and this includes LL, BL, BB.

1. Multibacillary  Rifampin 600mg once a month, supervised.  Dapsone 100mg daily, self administered.  Clofazimine 300mg once a month supervised, and 50mg daily self administered.  The duration is 12 months or it can be 2 years.

2. Paucibacillary  Rifampin 600mg once a month supervised.  Dapsone 100mg self administered.  Dapsone 100mg daily.  the duration is 6 months.

 ID/CC: A 19 year old military recruit comes to his medical officer complaining of red urine and orange colored staining of his T-shirt, he also complains that every time he takes rifampin, he feels as if he has the flu.  HPI: He underwent a routine physical exam and laboratory tests prior to joining the military camp and was started on rifampin at that time for meningococcal carrier state.

 PE: VS: normal, PE: muscular male in no acute distress, no jaundice, hepatomegaly, spider angiomas or parotid enlargement; nonpruitic maculopapular rash on chest and petechial hemorrhages on limbs.  Labs: AST and ALT moderately increased. UA: Proteinuria. CBC: thrombocytopenia.  Imaging: CXR is normal

 Treatment: Switch to Ceftriaxone or ciprofloxacin for eradication of meningococcal carrier state.  Discussion: Rifampin is an antituberculous drug that acts by inhibiting DNA-dependant RNA polymerase. One of its major drawbacks is the rapid development of resistance if used alone. Other side-effects include discoloration of urine and sweat with a yellowish orange, hepatic damage, skin rash, thrombocytopenia, and increased metabolism of anti-coagulants and HIV protease inhibitors.

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