## Multibacillary Leprosy & WHO MDT The clinical picture — **multiple lesions, high bacillary load (5+ on slit-skin smear), and systemic distribution** — defines **multibacillary (MB) leprosy** (BL, LL, or BT-borderline). ### WHO MDT Regimen for Multibacillary Leprosy **Key Point:** MB leprosy requires a **3-drug, 12-month MDT regimen**: - **Rifampicin** 600 mg monthly (supervised) + daily unsupervised - **Dapsone** 100 mg daily (unsupervised) - **Clofazimine** 300 mg monthly (supervised) + 50 mg daily (unsupervised) Total duration: **12 months** with monthly supervised doses. ### Comparison: PB vs MB MDT | Feature | Paucibacillary (PB) | Multibacillary (MB) | |---------|---------------------|---------------------| | **Bacillary Load** | 1–5 bacilli per field | >5 bacilli per field | | **Drugs** | Rifampicin + Dapsone | Rifampicin + Dapsone + Clofazimine | | **Duration** | 6 months | 12 months | | **Lesions** | ≤5 | >5 | | **Clofazimine** | Omitted | Essential | ### Role of Clofazimine in MB Leprosy **High-Yield:** Clofazimine is **bacteriostatic** (not bactericidal) but: 1. Prevents emergence of dapsone-resistant mutants 2. Reduces risk of relapse in high-bacillary-load disease 3. Has anti-inflammatory properties (reduces erythema nodosum leprosum risk) 4. Accumulates in fatty tissues, providing prolonged post-treatment suppression **Warning:** Clofazimine causes **brown-black discoloration of skin** (reversible over months to years after stopping). Counsel patients before starting. **Mnemonic:** **RDC for MB** — Rifampicin, Dapsone, Clofazimine for Multibacillary; **RD for PB** — Rifampicin, Dapsone for Paucibacillary. **Clinical Pearl:** Patients with MB leprosy remain infectious for ~2 weeks despite MDT; those with PB are non-infectious within 2 weeks. Both require isolation during this window. [cite:Park 26e Ch 8]
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