[Current guidelines for leprosy treatment].

Abstract

During the last 20 years, the global leprosy situation has strikingly changed with a decrease of cases from 12 millions estimated cases in 1982 to 600,000 registered cases in the year 2000. However, during the past 15 years, about 700,000 new cases are still detected annually. The systematic use of multidrug therapy (MDT), as recommended by a WHO Study Group in 1982, has proven its efficacy as assessed by the low reported relapse rate (less than 1% per year). The initial PCT schedule has been modified several times, but this PCT remains the recommended chemotherapy for the great majority of patients. New potent antibacillary drugs (ofloxacin, minocycline, clarithromycine) have been discovered; however, their current use is limited and should remain limited until under way trials could confirm their efficacy. With the use of PCT, the frequency of immunologically mediated reactional states have changed. The occurrence of reversal reaction, (type 1 reaction) has significantly increased while that of erythema nodosum leprosum (ENL, type 2) appeared less common. Because of the high risk of neurological permanent damage, reversal reaction needs to be diagnosed and treated as soon as possible. Here in, the current antibacillary and antireactionnal treatments are being reviewed.