Simplified treatment for leprosy.

Multidrug therapy (MDT)--the combination of three powerful anti-leprosy drugs--has now successfully cured more than 8.4 million sufferers since 1981, and the global strategy to eliminate the disease, which is based on MDT, is working extremely well. Consequently, the Seventh Expert Committee on Leprosy, which met at the World Health Organization (WHO) headquarters in Geneva from 26 May to 3 June, considered that, for a special class of early paucibacillary or PB leprosy--where patients have only one skin lesion--a single dose of three drugs in combination is sufficient to bring about a cure. The Committee also agreed on the possibility of shortening the treatment for the more severe form of the disease--multibacillary or MB leprosy--from 24 months to 12 months.

The United Nations Development Programme/World Bank/WHO Special Programme for Research and Training in Tropical Diseases initiated and supported a comprehensive multi-centre trial, which has shown that a combination of three drugs as a single dose--consisting of rifampicin (600 mg), ofloxacin (400 mg) and minocycline (100 mg)--is sufficient to cure patients with PB leprosy with single skin patches. The Committee considered that a single dose of this combination "is an acceptable and cost-effective alternative regimen for the treatment of single skin-lesion PB leprosy".

The implications of single-dose treatment for PB leprosy are considerable. Getting patients to comply with "doctor's orders" is a problem in any country. One visit by the patient to a health centre, where primary health care workers can supervise treatment, is clearly a much simpler matter than having to persuade each person to return for several treatments over a period of several months. There will also be welcome savings for cash-starved health services. For PB leprosy patients with more than one skin lesion, the standard treatment will continue to last for six months and consists of 600 mg rifampicin once a month and 100 mg dapsone daily.

Since 1994, the recommended standard treatment for MB leprosy has consisted of giving 24 months of treatment with rifampicin (600 mg once monthly), dapsone (100 mg daily) and clofazimine (300 mg once monthly and 50 mg daily). Now the Expert Committee has agreed that based on the information currently available, "it is possible that the duration of the current MDT regimen for MB leprosy could be further shortened to 12 months without increasing the risk of developing...