## Classification and MDT Selection This patient has **lepromatous leprosy (LL)** based on: - Multiple (>5) skin lesions - High bacillary load (4+ AFB on slit-skin smear) - Nerve involvement - Negative lepromin test (indicates poor cell-mediated immunity) ### WHO MDT Regimen for Lepromatous Leprosy **Key Point:** Lepromatous leprosy requires the **multibacillary (MB) regimen** of 3 drugs for 12 months. | Component | Drug | Dose | Frequency | |-----------|------|------|----------| | **Backbone** | Rifampicin | 600 mg | Monthly supervised | | **Backbone** | Dapsone | 100 mg | Daily self-administered | | **Backbone** | Clofazimine | 300 mg monthly + 50 mg daily | Monthly + daily | | **Duration** | — | — | **12 months** | **High-Yield:** The 3-drug MB regimen (RDC) is given for **12 months** in lepromatous and borderline lepromatous leprosy. Clofazimine is essential because it: - Reduces bacterial load slowly but steadily - Prevents drug resistance - Has anti-inflammatory properties - Improves cosmetic outcomes ### Why This Patient Needs 12-Month Therapy 1. **High bacillary burden** (4+ AFB) requires prolonged treatment 2. **Negative lepromin test** indicates lepromatous pole (worst prognosis) 3. **Nerve involvement** demands adequate drug levels to prevent further damage 4. **WHO guidelines** mandate 12 months for MB disease to ensure cure and prevent relapse **Clinical Pearl:** Patients with LL have the highest relapse rates if undertreated. The 12-month regimen reduces relapse to <1% compared to 5–10% with shorter courses. **Mnemonic:** **MB = 3 drugs × 12 months** (Rifampicin, Dapsone, Clofazimine for one year). 
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