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6.Chemotherapy And Dis Ability Preventation

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Text of 6.Chemotherapy And Dis Ability Preventation

  • 1. Leprosy treatment -chemotherapy
  • 2.
    • Leprosy is classified into paucibacillary or multibacillary leprosy based on the number of patches.
    • MULTIBACILLARY (MB) LEPROSY
    • 6 or more skin patches or more than one nerve
    • involvement
    • Treatment: 12 MB blister packs.
    • PAUCIBACILLARY (PB) LEPROSY
    • 1-5 skin patches or only
    • one nerve involvement
    • Treatment: 6 PB blister packs
  • 3.
    • The 1st line antileprotic drugs : Rifampicin, Dapson, Clofazimine. Rifampicin:
    • Potent bactericidal. Inhibits DNA dependent RNA polymerase.
    • Well absorbed orally.
    • Hepatotoxic.
  • 4.
    • Dapsone:(diamino-diphenyl sulfone) :
    • Blocking folic acid synthesis
    • Weakly bactericidal. Well absorbed orally, long half life. Hemolytic anaemia,methemoglobinemia, DDS syndrome (LN, hepatosplenomegaly, fever and hepatites)
    • Clofazimine : Dye, weakly bactercidal action, anti-inflammatory action. Skin discoloration, icthyosis on shins and forearms. GIT upset
  • 5.
    • WHO Multidrug therapy (MDT) :WHO Multidrug therapy (MDT) Since 1995, WHO has supplied MDT free of cost to leprosy patients in all endemic countries.
  • 6.
    • Each blister pack contains treatment for 4 weeks
    • PB adult treatment:
    • Once a month: Day 1
    • 2 capsules of rifampicin (300 mg X 2)
    • 1 tablet of dapsone (100 mg)
    • Once a day: Days 2-28
    • 1 tablet of dapsone (100 mg)
    • Full course : 6 blister packs.
  • 7.
    • PB adult blister pack
  • 8.
    • MB adult treatment:
    • Once a month: Day 1
    • - 2 capsules of rifampicin (300 mg X 2)
    • - 3 capsules of clofazimine (100mg X 3)
    • - 1 tablet of dapsone (100 mg
    • Once a day: Days 2-28
    • - 1 capsule of clofazimine (50 mg)
    • - 1 tablet of dapsone (100 mg)
    • Full course : 12 blister packs.
  • 9.
    • MB adult blister pack
  • 10.
    • PB child treatment (10-14 years):
    • Once a month: Day 1
    • - 2 capsules of rifampicin
    • - (300 mg + 150 mg)
    • - 1 tablet of dapsone (50 mg)
    • Once a day: Days 2-28
    • - 1 tablet of dapsone (50 mg)
    • Full course : 6 blister packs
  • 11.
    • MB child treatment (10-14 years):
    • Once a month: Day 1
    • - 2 capsules of rifampicin
    • - (300 mg + 150 mg)
    • - 3 capsules of clofazimine ( 50 mg X 3)
    • - 1 tablet of dapsone (50 mg)
    • Once a day: Days 2-28
    • - 1 capsule of clofazimine every other day
    • - (50 mg)
    • - 1 tablet of dapsone (50 mg)
    • Full course : 12 blister packs
  • 12.
    • Explain how to
    • use the Blister
    • Calendar Pack
    • (BCP). It is crucial
    • to explain which
    • tablets are to be
    • taken monthly
    • and which daily
  • 13.
    • Safety
    • MDT is very safe and effective in curing leprosy.
    • MDT is safe during pregnancy.
    • MDT is safe for patients being treated for tuberculosis (TB)
    • as well as those who are HIV-positive.
    • Rifampicin is common to the treatment of leprosy and TB
    • and must be given in doses required for TB.
  • 14.
    • Over 10 million people have been cured of leprosy with MDT
  • 15.
    • Leprosy reactions :
    • Type 1 or reversal reactions
    • Lesions caused by a change in the immunologic defence of the patient
    • 30% in borderline leprosy.
    • Erythema, swelling, and tenderness of skin lesions and tenderness of peripheral nerves
    • Type 2 reactions
    • Erythema nodosum leprosum.
    • 20% of LL and 10%of BL patients
    • Widespread erythema nodosum,neuritis, iritis, arthritis, orchitis, lymphoadenopathy and renal disease.
  • 16.
    • Severe ENL reactions include
    • Numerous ENL nodules with high fever-
    • ENL nodules and neuritis
    • Ulcerating and pustular ENL-
    • Recurrent episodes of ENL
    • Involvement of other organs (e.g. eyes, testes, lymph nodes and joints)
  • 17.
    • TREATMENT OF SEVERE ENL:
    • Maximum dose of prednisolone is 1 mg per kg of body weight.
    • 40 mg daily for weeks 1 and 2,
    • 30 mg daily for weeks 3 and 4,
    • 20 mg daily for weeks 5 and 6,
    • 15 mg daily for weeks 7 and 8,
    • 10 mg daily for weeks 9 and 10,
    • 5 mg daily for weeks 11 and 12.
  • 18.
    • Management with Clofazimine and Corticosteroids
    • Use standard course of prednisolone in dosage per day not exceeding 1 mg per Kg body weight.
    • Start clofazimine 100 mg three times a day for maximum of 12 weeks.
    • Complete the standard course of prednisolone. Continue clofazimine as below.
    • Taper the dose of clofazimine to 100 mg twice a day for 12 weeks and then 100 mg once a day for 12-24 weeks.
  • 19.
    • Leprosy can be easily cured!

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