Conditional use of chemoprophylaxis recommended as preventive treatment.
The WHO is about to release recommendations on the diagnosis, treatment and prevention of leprosy. An executive summary is now available online and the full recommendations will be published in the coming weeks.
On diagnosis, the guidelines recommend no additional tests beyond the standard methods of testing for patches on the skin with no sensation; thickened or enlarged peripheral nerves; or the presence of acid-fast bacilli in a slit-skin smear.
On treatment, the guidelines recommend a three-drug regimen of rifampicin, dapsone and clofazimine for all leprosy patients, with a duration of treatment of six months for patients with paucibacilliary (PB) leprosy and 12 months for those with multibacilliary (MB) leprosy.
This represents a change from the current standard two-drug treatment for PB leprosy using rifampicin and dapsone for six months, “due to some evidence indicating better clinical outcomes” with a three-drug regimen. Meanwhile, evidence on the potential benefits and harms of a shorter, six-month three-drug regimen for MB leprosy was “limited and inconclusive,” hence the guidelines do not recommend shortening the treatment duration for MB leprosy.
On prevention of leprosy through chemoprophylaxis, the use of single-dose rifampicin (SDR) as treatment is recommended for adult and child contacts of leprosy patients. Use of SDR in controlled trials is associated with a 57% reduction in leprosy in contacts over two years and 30% after five to six years.
However, SDR is only recommended if programs are able to “adequately identify and manage contacts” and only if the index case consents to disclose his/her disease to others, given the highly stigmatizing nature of leprosy.
For more information: www.searo.who.int/entity/global_leprosy_programme/en/