## MDT for Multibacillary Leprosy: Regimen Duration and Drug Continuation **Key Point:** In MB-MDT, **all three drugs (rifampicin, clofazimine, and dapsone) must be continued for the full 12 months**. Clofazimine is NOT discontinued at 6 months; this is a common misconception that leads to treatment failure and relapse. ### Standard WHO MB-MDT Regimen | Drug | Dose | Frequency | Duration | |---|---|---|---| | **Rifampicin** | 600 mg | Monthly supervised | 12 months | | **Clofazimine** | 50 mg | Daily self-administered | **12 months** | | **Dapsone** | 100 mg | Daily self-administered | **12 months** | **High-Yield:** The **12-month duration applies to ALL three drugs in MB-MDT**. Premature discontinuation of any drug, especially clofazimine, increases the risk of relapse and drug resistance. ### Why Clofazimine Must Continue for 12 Months 1. **Slow bactericidal action:** Clofazimine acts slowly and accumulates in tissues 2. **Relapse prevention:** Early discontinuation significantly increases relapse rates in MB leprosy 3. **Bacterial load reduction:** The full 12-month course is needed to adequately reduce the high bacillary load (BI > 4) in MB patients 4. **WHO guideline:** The WHO explicitly mandates 12-month continuation of all three drugs **Clinical Pearl:** Patients often ask why they must continue clofazimine for so long, especially since they become non-infectious within 2 weeks of starting rifampicin. The answer is that **non-infectiousness ≠ cure**. Clofazimine is essential for killing residual bacilli and preventing relapse. **Warning:** A common trap in exams is confusing the **12-month full regimen** with shortened regimens or regimens where drugs are dropped early. This is a **major cause of treatment failure** in clinical practice. ### Correct Statements (Options 0, 1, 2) **Option 0 (Correct):** 12-month MB-MDT with all three drugs is the standard. **Option 1 (Correct):** Rifampicin 600 mg monthly supervised is correct; patient becomes non-infectious within 2 weeks. **Option 2 (Correct):** Ofloxacin 400 mg monthly is a valid substitute for dapsone in G6PD deficiency or dapsone intolerance. This does NOT change the 12-month duration or the need to continue clofazimine. **Mnemonic:** **RCD-12** = **R**ifampicin + **C**lofazimine + **D**apsone for **12** months (all three, all 12 months).
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