Leprosy is caused by mycobacterium leprae. I t can be treated dapsone, rifampin, clofazimine, ethionamide, etc.
Because of increasing reports of dapsone resistance, treatment of leprosy with combinations of the drugs is recommended.
Dapsone
Dapsone (diaminodiphenylsulfone) is the most widely used drugs in the treatment of leprosy and it inhibits folate synthesis. Resistance can emerge in large populations of M leprae. Therefore, the combination of dapsone, rifampin, and clofazimine is recommended for initial therapy. Sulfones are well absorbed from the gut and widely distributed throughout body fluids and tissues. Excretion into urine is variable, and most excreted drug is acetylated.
Dapsone is usually well tolerated. Gastrointestinal intolerance, fever, pruritus, and rashes occur. Erythema nodosum often develops during dapsone therapy in lepromatous leprosy. Erythema nodosum leprosum may be suppressed by corticosteroids. Hemolysis and methemoglobinemia can occur.
Rifampin
This drug is effective in lepromatous leprosy. Because of the probable risk of emergence of rifampin-resistant M leprae, the drug is given in combination with dapsone or another antileprosy drug.
Clofazimine
The absorption of clofazimine from the gut is variable, and a major portion of the drug is excreted in feces. Clofazimine is stored widely in reticuloendothelial tissues and skin. Clofazimine is given for sulfone-resistant leprosy or when patients are intolerant to sulfone. A common dosage is 100 mg/d orally. The most prominent untoward effect is skin discoloration ranging from red-brown to nearly black.
Leave a Reply