Abstract
Post-exposure prophylaxis (PEP) for leprosy is administered as one single dose of rifampicin (SDR) to the contacts of newly diagnosed leprosy patients. SDR reduces the risk of developing leprosy among contacts by around 60 % in the first 2–3 years after receiving SDR. In countries where SDR is currently being implemented under routine programme conditions in defined areas, questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M. tuberculosis strains circulating in these areas. This issue has not been addressed in scientific literature to date. To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis, a meeting was convened with tuberculosis (TB) and leprosy experts. The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of (multi) drug-resistance in M. tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy. They concluded that SDR given to contacts of leprosy patients, in the absence of symptoms of active TB, poses a negligible risk of generating resistance in M. tuberculosis in individuals and at the population level. Thus, the benefits of SDR prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M. tuberculosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0140-y) contains supplementary material, which is available to authorized users.
Highlights
In post-exposure prophylaxis (PEP) for leprosy, one single dose of rifampicin (SDR) (600 mg for adults and appropriately reduced doses for children) is administered to the contacts of newly diagnosed leprosy patients to reduce their risk of developing leprosy
Administration of SDR to an individual with sub-clinical TB disease or a latent TB infection bears negligible risk of that individual developing rifampicin-resistant TB as the number of M. tuberculosis bacilli make it highly unlikely that the relevant mutation were present at the time of SDR administration, and no selective pressure would continue to exist to favour the growth of resistant bacilli
Regular sampling and molecular monitoring for mutations associated with rifampicin resistance in M. tuberculosis as well as in M. leprae should be considered in areas where SDR is given to contacts of leprosy patients
Summary
In post-exposure prophylaxis (PEP) for leprosy, one single dose of rifampicin (SDR) (600 mg for adults and appropriately reduced doses for children) is administered to the contacts of newly diagnosed leprosy patients to reduce their risk of developing leprosy. The scientific literature has not addressed this issue to date For this reason, an expert meeting was convened to assess the risk of drug resistance in M. tuberculosis by administering SDR to contacts of leprosy patients. Administration of SDR to an individual with sub-clinical TB disease or a latent TB infection bears negligible risk of that individual developing rifampicin-resistant TB as the number of M. tuberculosis bacilli make it highly unlikely that the relevant mutation were present at the time of SDR administration, and no selective pressure would continue to exist to favour the growth of resistant bacilli. The options for initial screening of adults and children aged 10 years and older include TB symptom screening or screening with chest radiography, which is more sensitive and more expensive
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