## Classification and MDT Selection **Key Point:** The patient presents with lepromatous leprosy (LL) based on: - Multiple (>5) well-demarcated lesions - Negative lepromin test (indicates poor cell-mediated immunity) - Positive AFB on slit-skin smear with bacillary index ≥2 ### WHO MDT Regimens for Leprosy | Classification | Lesions | Bacillary Index | MDT Regimen | Duration | |---|---|---|---|---| | **Paucibacillary (PB)** | ≤5 | Negative/Low | Rifampicin + Dapsone | 6 months | | **Multibacillary (MB)** | >5 | ≥2 | Rifampicin + Dapsone + Clofazimine | 12 months | ### MDT Regimen for Multibacillary Leprosy (MB) **Monthly supervised doses:** 1. Rifampicin 600 mg 2. Dapsone 100 mg 3. Clofazimine 300 mg **Daily unsupervised doses (at home):** - Dapsone 100 mg - Clofazimine 50 mg **High-Yield:** Clofazimine is essential in MB leprosy because: - Provides bacteriostatic activity - Reduces relapse rates - Prevents dapsone resistance - Improves treatment outcomes significantly **Clinical Pearl:** The negative lepromin test in this patient confirms lepromatous leprosy (LL is at the lepromatous pole of the Ridley-Jopling classification), which is always multibacillary and requires the 3-drug regimen. **Warning:** Do NOT use the 6-month PB regimen (Rifampicin + Dapsone alone) in this patient—it would result in treatment failure and relapse. The presence of >5 lesions and high bacillary index mandates the 12-month MB regimen with clofazimine. **Mnemonic:** **MB = 3 drugs, 12 months** (Rifampicin, Dapsone, Clofazimine for 12 months); **PB = 2 drugs, 6 months** (Rifampicin, Dapsone for 6 months) [cite:Park 26e Ch 7] 
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