minocycline and Leprosy--Borderline

Daily, long-term treatment with minocycline 100 mg and rifampin 600 mg was initiated in 24 previously untreated borderline lepromatous (BL) and lepromatous (LL) patients for a total of 646 patient-months, averaging 26.9 months per patient. The same regimen was started in 12 BL and LL patients having a bacteriologic relapse for a total of 379 patient-months, averaging 32.5 months per patient, and in 12 patients judged to be at high risk for relapse for a total of 354 patient-months, averaging 29.5 months per patient. Daily, long-term treatment with clarithromycin 500 mg and rifampin 600 mg was initiated in 8 previously untreated BL and LL patients for a total of 174 patient-months, averaging 21.8 months per patient. The results in these 56 patients were compared to those obtained in 34 previously untreated BL and LL patients who were treated concurrently receiving daily, long-term dapsone 100 mg and rifampin 600 mg. No evidence of dangerous drug reactions or bone marrow, kidney or liver toxicity was seen in any of these five patient groups. Drug intolerance in 10 of the 90 patients studied necessitated discontinuing the chosen regimen, 4 from rifampin, 3 from dapsone, 2 from minocycline and 1 of undetermined attribution. The use of either minocycline or clarithromycin in conjunction with rifampin appears to pose no great risk when used long term.

Topics: Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Leukopenia; Male; Minocycline; Recurrence; Rifampin

Twelve patients were treated with three dose levels of minocycline for 30 days, primarily to detect the dose-related effects on Mycobacterium leprae viability, followed by another 5 months of daily minocycline for overall efficacy and persistence of clinical and antibacterial effects. Subsequently, the patients were given standard WHO/MDT chemotherapy for multibacillary leprosy. Clinical improvement was recognizable during the first month, occurring much earlier among those on minocycline 200 mg daily than those who received minocycline 100 mg daily. A similar change also was observed in one patient 11 days after three daily doses of 100 mg of minocycline. At the end of 6 months, all patients were clinically improved with a slight reduction in the average bacterial index (BI) and logarithmic index of bacilli in biopsy (LIB). The effects of minocycline on viability by mouse foot pad inoculation and palmitic acid oxidation assays were noted beginning at 10 to 14 days of daily dosing and becoming more definite after 30 days of treatment. Both tests correlated fairly well. Doses of 200 mg daily did not appear to be more efficient than minocycline 100 daily. Phenolic glycolipid-I (PGL-I) antigen determinations done on some patients during the first month remained positive and did not correlate with changes in viability results. At the end of 6 months, after 5 months of 100 mg of minocycline monotherapy, no viable organisms could be demonstrated by mouse foot pad inoculation and palmitic acid oxidation assays; assays for PGL-I antigen were all negative.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Animals; Antigens, Bacterial; Colony Count, Microbial; Drug Therapy, Combination; Female; Glycolipids; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Mice; Mice, Inbred CBA; Minocycline; Mycobacterium leprae; World Health Organization

A clinical trial of minocycline in a total of 10 patients with previously untreated lepromatous leprosy was conducted in order to evaluate the efficacy of a single, initial, 200-mg dose and 100 mg twice daily of minocycline for a total duration of up to 3 months. Patients improved remarkably quickly. Although single-dose therapy did not result in a significant killing of Mycobacterium leprae, viable M. leprae were cleared from the dermis regularly by 3 months of twice-daily therapy, a rate similar to that achieved by minocycline 100 mg once daily. Because more side effects were noted herein than previously with 100 mg daily, we recommend that minocycline, when applied, be administered at 100 mg daily to leprosy patients.

Topics: Adolescent; Adult; Aged; Animals; Drug Administration Schedule; Female; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Male; Mice; Mice, Inbred BALB C; Middle Aged; Minocycline; Mycobacterium leprae; Skin

Hansen Disease (leprosy) is an infectious disease that targets macrophages and Schwann cells, caused by the acid fast intracellular organism, Mycobacterium leprae. Clinically, it presents with a spectrum of findings that may include hypopigmented macules, erythematous plaques and nodules, and thickened or tender peripheral nerves. The most feared complication is mutilating damage to facial structures or digits resulting from loss of sensation in affected skin. In non-endemic areas, the diagnosis of leprosy is frequently delayed because it may mimic other more common skin conditions. We present a case of borderline/lepromatous leprosy in an otherwise healthy young Brazilian man that was initially diagnosed as tinea versicolor, but did not respond to appropriate treatment. This case highlights the importance of having a high index of suspicion for leprosy in patients from endemic areas who present with lesions that could be consistent with this disease.

Topics: Clofazimine; Contraindications; Dapsone; Delayed Diagnosis; Diagnostic Errors; Humans; Hypesthesia; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Male; Minocycline; Mycobacterium leprae; Rifampin; Tinea Versicolor; Young Adult

Topics: Aged; Clofazimine; Humans; Leprosy, Borderline; Leprosy, Lepromatous; Male; Minocycline; Mycobacterium leprae; Prednisone; Rifampin; Treatment Outcome

Cutaneous biopsies were collected from leprosy patients who attended the out-patient department of the Institute for treatment at different intervals, i.e., 12 months, 18 months, 24 months, 36 months, and more after beginning the multi-drug treatment therapy (M.D.T.). The patients belonged to the two drug regimens; (i) standard multibacillary (MB) M.D.T. after 12, 24, and 36 months; or (ii) standard M.D.T. + Minocycline 100 mg once a month (supervised) + Ofloxacin 400 mg once a month supervised for 12 months Biopsies were processed for mouse footpad inoculation and for estimating ATP levels by bioluminescence assay as per established methods. Viable bacilli were observed in 23.5% up to 1 year, 7.1% at 2 years, and in 3.84% at 3 years of M.D.T. by MFP and 29.4%, 10.7%, and 3.84% by ATP assay in the M.D.T. group at the same time period, respectively, but not in M.D.T. + Minocycline + Ofloxacin group after one year. The overall percentage of persisters was 5.55% by MFP and 7.14% by ATP assay up to 3 years of treatment.

Topics: Adenosine Triphosphate; Adolescent; Adult; Anti-Bacterial Agents; Colony Count, Microbial; Drug Administration Schedule; Drug Therapy, Combination; Follow-Up Studies; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Middle Aged; Minocycline; Mycobacterium leprae; Ofloxacin; Skin; Treatment Failure

Topics: Adolescent; Anti-Infective Agents; Drug Therapy, Combination; Extremities; Female; Follow-Up Studies; Humans; Leprostatic Agents; Leprosy, Borderline; Minocycline; Mycobacterium leprae; Ofloxacin; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pulse Therapy, Drug; Rifampin; Skin; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Dapsone; Drug Monitoring; Granuloma; Histiocytes; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Lymphocytes; Male; Minocycline; Ofloxacin; Recurrence; Rifampin