Leprosy Multidrug Therapy
On this page
Direct answer
Multidrug therapy (MDT) for leprosy is a WHO-recommended combination of rifampicin, dapsone and clofazimine, given free of cost, that cures the infection and prevents drug resistance. Uniform MDT means the same three-drug combination is used for every patient, while the duration depends on classification: six months for paucibacillary disease and twelve months for multibacillary disease. Rifampicin is the most important drug, and it is never given alone.
What you must remember
- Rifampicin: the most important bactericidal drug, given monthly under supervision at 600 mg in adults; monotherapy quickly selects resistant bacilli.
- Dapsone: 100 mg daily in adults, self-administered; risks include haemolysis in G6PD deficiency, methaemoglobinaemia and dapsone hypersensitivity syndrome.
- Clofazimine: 300 mg monthly under supervision plus 50 mg daily at home in adults; it causes reddish-brown skin discolouration and has anti-reactional effects.
- Paucibacillary regimen: six months of the three-drug combination under current WHO guidance, which India adopted in 2025; the older regimen used only rifampicin and dapsone.
- Multibacillary regimen: twelve months of rifampicin, clofazimine and dapsone.
- Release from treatment: PB patients are released after six monthly doses within nine months, and MB patients after twelve monthly doses within eighteen months.
- Rifampicin toxicity: hepatotoxicity, orange discolouration of body fluids and flu-like reactions when given intermittently.
- Uniform MDT rationale: one combination for all patients reduces misclassification and simplifies drug supply and training.
Regimens side by side
The two categories share the same three drugs, and they differ mainly in duration and in the clofazimine component. The table sets out the standard adult doses, which should be checked against the current NLEP and WHO documents before use.
| Component | Paucibacillary (PB) | Multibacillary (MB) |
|---|---|---|
| Rifampicin | 600 mg monthly, supervised | 600 mg monthly, supervised |
| Dapsone | 100 mg daily, self-administered | 100 mg daily, self-administered |
| Clofazimine | 300 mg monthly, supervised, plus 50 mg daily | 300 mg monthly, supervised, plus 50 mg daily |
| Duration | Six months | Twelve months |
Monthly supervised rifampicin provides the high intermittent dose that rapidly kills bacilli, while daily dapsone and home clofazimine maintain pressure between visits. Because leprosy guidance has changed recently, the durations and doses in this table should be confirmed against the latest documents before they are applied to a patient. Clinicians also record the number of doses completed at each visit, because release from treatment is judged from that count.
Where the exam catches students
Most traps involve monotherapy, premature release or applying the wrong duration.
- Trap: giving rifampicin alone to a patient who cannot afford the full course Correct: monotherapy selects resistant bacilli, so MDT is always given as a combination.
- Trap: stopping treatment when the skin lesions have healed Correct: release depends on completing the prescribed number of monthly doses within the time limit, not on clinical healing.
- Trap: using the twelve-month regimen for every patient Correct: the category sets the duration, so PB patients finish at six months even under the uniform drug combination.
- Trap: treating dapsone hypersensitivity as an ordinary drug rash Correct: dapsone hypersensitivity syndrome, with fever, rash and hepatitis, requires stopping the drug and prompt review.
Frequently asked questions
What is uniform MDT in leprosy?
Uniform MDT gives the same combination of rifampicin, clofazimine and dapsone to every leprosy patient regardless of classification. The duration still depends on category, with six months for paucibacillary and twelve months for multibacillary disease.
What is release from treatment in leprosy?
Release from treatment is the point at which a patient has completed the prescribed number of monthly doses within the time limit and stops therapy. Paucibacillary patients are released after six monthly doses within nine months, and multibacillary patients after twelve monthly doses within eighteen months.
Why is rifampicin never given alone in leprosy?
Rifampicin given alone rapidly selects resistant mutants of Mycobacterium leprae. Combination therapy with dapsone and clofazimine prevents this, and it is the principle that defines multidrug therapy.
What are the main side effects of dapsone in leprosy?
Dapsone can cause haemolysis in patients with G6PD deficiency and methaemoglobinaemia, and it can cause dapsone hypersensitivity syndrome with fever, rash and hepatitis. Suspected dapsone hypersensitivity requires the drug to be stopped and the patient reviewed promptly.