## First-Line Drug for Lepromatous Leprosy **Key Point:** Rifampicin is the most potent anti-leprosy drug and forms the backbone of all WHO multidrug regimens for both tuberculoid and lepromatous leprosy. ### Mechanism and Efficacy Rifampicin inhibits bacterial RNA polymerase, rapidly killing *Mycobacterium leprae*. It is bactericidal and renders patients non-infectious within 2 weeks of starting therapy. ### WHO Multidrug Therapy (MDT) Regimen for Lepromatous Leprosy | Component | Drug | Duration | Role | |-----------|------|----------|------| | **Backbone** | Rifampicin 600 mg monthly (supervised) | 12 months | Most potent; bactericidal | | **Adjunct 1** | Dapsone 100 mg daily (unsupervised) | 12 months | Bacteriostatic; prevents resistance | | **Adjunct 2** | Clofazimine 50 mg daily (unsupervised) | 12 months | Anti-inflammatory; slow-acting | **High-Yield:** The WHO regimen uses a 3-drug combination specifically to prevent drug resistance and ensure cure. Rifampicin alone would lead to resistance if used monotherapy. ### Why Rifampicin is Essential 1. **Rapid bactericidal action** — kills 99% of bacilli within 2 weeks 2. **Prevents relapse** — ensures sterilization of lesions 3. **Non-infectious status** — patient becomes non-contagious quickly 4. **Backbone of all regimens** — mandatory in both paucibacillary and multibacillary disease **Clinical Pearl:** Patients on rifampicin may develop red-orange discoloration of body fluids (tears, urine, sweat) due to its lipophilic nature — counsel patients to prevent alarm. **Mnemonic: RDC** — **R**ifampicin (backbone), **D**apsone (adjunct), **C**lofazimine (adjunct) = WHO MDT for lepromatous leprosy.
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