Welcome to Primary Health Care worker Training in Leprosy Module 2 'Compliant Treatment with MDT'

Welcome to Primary Health Care worker Training in Leprosy Module 2 ‘Compliant Treatment with MDT’.

In the second module we will learn about the importance of early and compliant treatment of leprosy and how it can be ensured among those who have been started on treatment.

The learning objectives of Module 2 ‘Compliant Treatment with MDT’ are At the end of the module the learner will be able to 1) Outline the importance of early, regular and complete treatment of leprosy 2) List the major groups of leprosy with their clinical features.

3) Name the medicines used in the treatment of leprosy and outline the treatment regimen for each group of leprosy 4) Know the side effects of medicines and how to advise the patient in case of side effects 5) List the criteria for completion of MDT course.

6) Know methods to check for regularity of treatment and its completion 7) Define a defaulter and know now to trace and put him back on MDT.

Learning Objective 1 “Outline the importance of early, regular and complete treatment of leprosy” In the first learning objective of this module, - we will focus on knowing the importance of regular and complete treatment of leprosy.

There are four reasons for early, regular and complete treatment of leprosy 1) To cure leprosy – medicines will get rid of all the bacilli of M Leprae and provide a cure from the disease 2) Delay in treatment of leprosy can lead to development of nerve damage and its consequences like deformities of hands, feet and eyes.

3) If MDT is not taken regularly and is stopped or taken with gaps drug resistance to anti leprosy drugs will develop and treatment will be can ineffective against leprosy bacilli 4) Regular MDT will break transmission of leprosy by killing all the bacilli. This prevents shedding of bacilli into environment thus breaking transmission of leprosy.

Learning Objective 2 ‘List the major groups of leprosy with their clinical features’ In the second learning objective of this Module, we will learn about the two major groups of leprosy with their clinical features.

For the purpose of treatment leprosy is classified into two groups by World Health Organization (WHO) 1) Pauci-Bacillary (PB) 2) Multi-Bacillary (MB) Pauci-Bacillary (PB) Leprosy cases have - Five or less skin patches or - Only one nerve enlargement with or without five or less skin patches Multi- Bacillary Leprosy cases have - Six or more skin patches or - More than one nerve enlargement irrespective of number of skin patches.

Learning Objective 3 ‘Name the medicines used in the treatment of leprosy and outline treatment regimen for each group of leprosy In the third learning objective of this module, we will name the medicines used in leprosy and the outline treatment regimen used for each group of leprosy.

Medicines used in Leprosy are 1) Rifampicin 2) Clofazimine 3) Dapsone (DDS) These medicines are used in combination as Multi Drug Therapy (MDT).

Treatment Regimen for leprosy WHO - Paucibacillary MDT – Adult Regimen 1) Rifampicin – 600 mg - once a month 2) DDS – 100 mg - once a day These two drugs are given for six months in paucibacillary leprosy WHO - Multibacillary MDT – Adult Regimen 1) Rifampicin – 600 mg – once a month 2) Clofazimine - 300 mg – once a month 50 mg – once a day 3) DDS – 100 mg once a day These three drugs are given for twelve months in multibacillary leprosy.

Paucibacillary MDT – Child Regimen Age 10-14 1) Rifampicin – 450 mg – once a month 2) DDS – 50 mg - once a day These two drugs are given for six months in paucibacillary leprosy Age - less than 10 years Regimen remains as above, but dosages of medicines will have to be calculated according to body weight.

Multibacillary MDT– Child Regimen Age 10-14 1) Rifampicin – 450 mg – once a month 2) Clofazamine - 150 mg – once a month 50 mg – alternate days 2) DDS – 50 mg - once a day These three drugs are given for twelve months in multibacillary leprosy Age - less than 10 years Regimen remains as above, but dosages of medicines will have to be according to body weight.

MDT Blister packs. Four types of blister packs are provided by WHO free of cost On the left side are the Adult packages On the right side are the Child packages Details of how to take it are also explained in this slide.

Learning Objective 4 ‘Know the side effects of medicines and how to advise the patient in case of side effects’ In this learning objective we will learn about major side effects of medicines in MDT.

Side Effects of Medicines in MDT Rifampicin Mild - Reddish discoloration of urine, saliva or sweat – Reassure patient - Flu like symptoms – Symptomatic treatment Serious - Vomiting – Jaundice – Stop Rifampicin and Refer - Skin rash or allergy – Stop Rifampicin and Refer.

Clofazamine - Brownish red discoloration of skin, urine, body fluids - Dryness of skin or eyes –Oil to skin and eye drops Dapsone - Paleness, tiredness or swelling of feet – Anemia – Deworm and Iron supplements Serious - Skin reaction – scaling – Stop Dapsone and Refer - Jaundice – Stop Dapsone and Refer.

Learning Objective 5 ‘List the criteria for completion of MDT course’ In this learning objective we will list the criteria for completion of MDT course.

Criteria for completion of either PB or MB MDT are very important a) in determining the end of treatment for a person with leprosy b) in calculating treatment compliance rates in a leprosy program..