BACKGROUND: Lepra reactions occur in 10-30% of patients with leprosy. The standard of treatment is prednisone. However , prolonged steroid use may cause side effects such as osteoporosis, hypertension, hyperlipidemia, atherosclerosis and infections. Fusidic acid targets cytokine systems responsible for the production of Type 1 lepra reaction (T1R) and erythema nodosum leprosum (ENL). It may be given as a steroid-sparing agent in treating lepra reactions.

OBJECTIVE: To determine the safety and efficacy of fusidic acid as a steroid-sparing agent in the treatment of  Type 1 and Type 2  lepra reactions.

METHODS: A randomized controlled trial was conducted on 67 subjects with lepra reactions, aged 18-60, each assigned to receive either prednisone or prednisone + fusidic acid for 12 weeks. Severity of lepra reactions were graded quantitatively using a modified scale by Walker et al and van Brakel et al, and qualitatively using modified National Leprosy Control Program (NLCP) Guidelines at baseline, weeks 2,4,6,8,10 and 12. Doses of prednisone needed to control lepra reactions were also noted at each follow up and statistical analyses were done . Adverse reactions were noted.

RESULT: Sixty subjects (89.55%) completed the study. The prednisone + fusidic acid group had lower quantitative and qualitative scores compared to the prednisone group. There were significant differences between the two groups for the quantitative severity scores (p=1.44x10-11) and qualitative severity grading (p=9.36x10-14) at week 12. The mean dose of prednisone was 21.5 mg in the prednisone group and 2 mg in the prednisone + fusidic acid group at week 12 (p=1.01x10-12). No adverse reactions were reported.

CONCLUSION: Fusidic acid tablet 250mg/tab two tablets three times a day is an effective and safe steroid-sparing agent for the treatment of lepra reactions.

Human ; Male ; Female ; Leprosy ; Prednisone

Leprosy is a chronic, infectious disease caused by Mycobacterium leprae. One of the main problems faced by clinicians and patients, is the development of leprosy-specific immunologic phenomena known as reactions. Lepra reactions are characterized by acute inflammation that appears suddenly before, during and after treatment of leprosy. When immune reaction increases, serious complications such as irreversible nerve damage, permanent disability, iridocyclitis and other organ involvement may ensue. There are two types of leprosy reactions: type I which is a type IV cell-mediated reaction, and type II lepra reaction, also called erythema nodosum leprosum (ENL), which is a type III hypersensitivity reaction. We report a case of a 37-year-old female who has been diagnosed with lepromatous type of Hansen's Disease and has been treated with multi-drug multibacillary therapy composed of rifampicin 600mg monthly, dapsone 100 mg daily, clofazimine 300 mg monthly and clofazimine 10 mg daily for 18 months. For two years, she has been experiencing recurrent type II lepra reaction which was treated with systemic corticosteroids. Appearance of ulcers with associated myalgia, arthralgia and fever prompted the addition of clofazimine, which is the drug of choice for female patients with childbearing potential. Prednisone was started at 1mg/kg and clofazimine 100mg three times a day for three months, which were subsequently tapered off. We stress the importance of early diagnosis for proper treatment of this condition is important to prevent further complications and other organ involvement.

Human ; Female ; Adult ; Adrenal Cortex Hormones ; Arthralgia ; Clofazimine ; Communicable Diseases ; Dapsone ; Early Diagnosis ; Erythema Nodosum ; Fever ; Immune Complex Diseases ; Inflammation ; Iridocyclitis ; Leprostatic Agents ; Leprosy ; Myalgia ; Mycobacterium Leprae ; Prednisone ; Rifampin ; Ulcer