20th June 2018, Colchester – Leading UK Leprologist, Professor Diana Lockwood and a team of academics argue that single-dose rifampicin (SDR) treatment is not an effective method for preventing multibacillary (MB) leprosy in a letter published in PLOS . Currently there is no known way of completely preventing leprosy, though it is not known to be very infectious.

SDR has been advocated by some since November 2017. However, the effectiveness of the treatment is limited and its method of administration poses ethical implications. Its widespread use could also promote the development of rifampicin resistance in Mycobacterium leprae, which would be a serious problem as Rifampicin is the drug of choice for treating leprosy.

Professor Lockwood, who is a Trustee at leprosy charity, Lepra, states that SDR does not prevent the development of MB leprosy or immediate household contacts. MB is the most infectious form of the disease, whereas paucibacillary (PB) cases are considered non-infectious. Single Dose Rifampicin has only been found to be effective for patients living in neighbouring households of anyone found with leprosy and ineffective against those who are infectious to others.

There are also ethical problems related to identifying the contacts of patients with leprosy. 25% of people refused to take the treatment through fears of having their leprosy status disclosed due to the prejudice of the disease .

The widespread use of SDR could promote the development of rifampicin resistance genes in Mycobacterium leprae. Proponents of SDR have considered the risk of rifampicin resistance developing in people with M. tuberculosis infections, but the possibility of M. leprae resistance has not been sufficiently considered.

Professor Lockwood says, “SDR is not a cost effective treatment and it protects those who need it least. It does not significantly reduce the number of patients with MB leprosy and it is highly unlikely to prevent transmission. Instead, efforts in case detection should be amplified to find and issue multidrug therapy to those affected.”

Geoff Prescott, Chief Executive at Lepra says, “Time and funds should be invested in increasing active case finding methods to ensure that people are found and treated in the early stages to reduce transmission and disability – SDR is diverting attention away from this known, effective control method.”

Find out more about Lepra’s work at lepra.org.uk