Leprosy mailing list - 18 December 2003

Ccn:      all;
Ref:       Fitzpatrick's Dermatology in General Medicine - treatment of leprosy;
From:    V Pannikar, Geneva, Switzerland.

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Dear Dr Noto,

In response to Dr Bendick's queries (lml 17 Dec 2003):

1.
Days of monotherapy with any drug are over.

2.
All antileprosy drug regiments should include rifampicin. The only exception could be adverse drug reaction to rifampcin (and proven, rifampicin resistance).

3.
WHO recommends 12 month MDT regimen for MB leprosy.

4.
The report of 20% relapse is not confirmed by others. Even this report is subject to wrong use of denominator (please see related publication over several years from the same institution and from the same cohort of patients).

5.
"Often use" does not mean anything (I am surprised that this was even accepted for publication.)

6.
It is unethical to subject an individual suffering from leprosy to treat for longer duration than necessary. The burden of disease carries the bigger burden of stigma.

7.
"Well tolerated" does not mean it is effective or it is adverse reaction free or is cost-effective.

8.
WHO does not agree to distinguish rich and poor in the context of health care.  It will be clear human rights violation if different treatment regimens are proposed for the rich and poor.  The WHO recommended regimen is for universal use, irrespective of cast, creed, religion or ethnicity or any other man-made differences.

 

Hope this helps

Best wishes and have a successful new Year.

Regards,

Dr V. Pannikar

Leprosy Elimination Programme

WHO, Geneva