A guide for surveillance of antimicrobial resistance in leprosy: 2017 update
The emergence of drug resistance is a concern and a threat for many infectious disease intervention programmes, especially those that have secondary prevention (chemotherapy) as the main component of their control strategy. The fight against leprosy has been a great success, largely due to the development of multidrug therapy (MDT) in 1981. The roll-out of MDT in the late 1980s has been a major factor in bringing down dramatically the burden of leprosy until the year 2005, after which a plateau was observed in the number of cases on treatment, and a much slower reduction in notification. As rifampicin is the backbone of the MDT regimen, it is important to monitor the emergence of rifampicin-resistant strains, as recent reports and publications have indicated the existence of rifampicin resistance in several endemic areas. Prior to the introduction of MDT, patients were treated with dapsone monotherapy for several years. Resistance to dapsone has been reported since the early 1960s. In case of resistance to rifampicin, fluoroquinolones become the preferred category of second-line drugs. Unfortunately, quinolone-resistant strains of Mycobacterium leprae have also been reported in several countries, probably due to the extensive use of quinolones for treating several types of infections. Clofazimine resistance is still rare but this antimicrobial cannot be given alone. To meet the challenge of containing the disease and being able to respond to an increase in circulation of drug-resistant strains, it is essential to assess drug-sensitivity patterns globally, as well as to monitor resistance among both new and retreatment cases.