Guideline for the treatment of Hansen's disease in Japan

Abstract

Ad hoc committee of Japanese Leprosy Association recommends standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 1997). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (B1) ≥3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. (A-1) When satisfactory decrease of B1 (B1 value decrease ≥2 steps, or final B1<3) is obtained after completion of 2 years MDT/MB, maintenance therapy by dapsone and clofazimine is recommended until B1 negativity and loss of active lesions. (A-2) When B1 decrease is not satisfactory (B1 value decrease <2 steps, or final B1≥3), MDT/MB should be continued until B1 negativity and loss of active lesions. (B) For MB with B1<3 or fresh MB (less than 6 months after the onset of the disease) with B1≥3, 1 year treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. (B-1) When B1 become negative and active lesion is lost within one year, no maintenance therapy is necessary. (B-2) When B1 is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.