{ "schema_version": 1, "kind": "condition", "id": "leprosy", "name": "Leprosy (Hansen's Disease)", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.06 - condition scope only, no dose · Leprosy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK559307/ · Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292)", "review_status": "reviewed", "verified_against": "Leprosy (Hansen's Disease) - disease-level clinical article (leprosy-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292)", "verified_date": "2026-08", "treatments": [ { "id": 1109, "generic": "Dapsone", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg once daily, always with rifampicin (and with clofazimine in multibacillary disease)", "adult_duration": "WHO: 6 months paucibacillary, 12 months multibacillary. US National Hansen's Disease Program: 12 and 24 months", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (dapsone monograph, p292)", "rationale": "The formulary's first listed indication for dapsone is treatment of leprosy due to susceptible strains of Mycobacterium leprae, and its dosing paragraph gives both regimens side by side - the WHO's and the US National Hansen's Disease Program's - which differ only in how long treatment runs. Never given alone: the formulary and the disease article both state that multidrug therapy is what prevents resistance, and resistance to dapsone monotherapy is documented history, not theory.", "cautions": [ "TREAT THROUGH THE NATIONAL PROGRAMME, NOT FROM A REFERENCE ENTRY. The formulary itself says treatment should be managed in consultation with a leprosy expert. Leprosy is notifiable; contacts need tracing and the regimen runs for 6 to 24 months.", "CLOFAZIMINE, THE THIRD DRUG IN MULTIBACILLARY DISEASE, IS NOT IN THE EGYPTIAN FORMULARY. The disease article gives it as 50 mg daily. It has to be obtained through the programme.", "Dapsone causes haemolysis, and severely so in G6PD deficiency - common in Egypt. Check before starting and watch the haemoglobin.", "Do not give to anyone with a known allergy to dapsone.", "Nerve damage, not the skin patch, is what disables. Reactions during treatment (type 1 and type 2) need urgent specialist care, not a change of antibiotic." ], "peds_mgkg_low": 1.0, "peds_mgkg_high": 2.0, "peds_max_mg": 100.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "THE TWO PROGRAMMES DIFFER, AND THE GRID SPANS BOTH. US National Hansen's Disease Program 2018: 1 mg/kg once daily, maximum 100 mg, for 12 months in paucibacillary disease. WHO 2016: children under 10 years and under 20 kg, 2 mg/kg once daily for 6 months; children 10 years and over and adolescents up to 14 years weighing 20-40 kg, a flat 25 mg once daily for 6 months. Both are given with rifampicin.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 10, "high_mg": 20, "capped": false }, { "weight_kg": 20, "low_mg": 20, "high_mg": 40, "capped": false }, { "weight_kg": 30, "low_mg": 30, "high_mg": 60, "capped": false }, { "weight_kg": 40, "low_mg": 40, "high_mg": 80, "capped": false } ], "brands": [ { "trade_name": "DAPSONE 100MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 158.0, "pack_count": 20, "unit_price": 7.9, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "leprosy" }, { "id": 1110, "generic": "Rifampicin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 300.0, "adult_dose": "600 mg daily, with dapsone", "adult_duration": "12 months for tuberculoid disease; 24 months for lepromatous disease, with clofazimine", "dose_source": "Leprosy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK559307/", "rationale": "The cited disease article gives the regimens directly: tuberculoid disease, dapsone 100 mg daily with rifampicin 600 mg daily for 12 months; lepromatous disease, dapsone, rifampicin and clofazimine 50 mg daily for 24 months. The dose is cited to that article and not to the formulary for a reason worth stating plainly: the Egyptian formulary's rifampicin monograph lists only tuberculosis and meningococcal carriage as indications, so it does not answer for leprosy. What the formulary does confirm is the pairing - its dapsone monograph names rifampin as the drug dapsone is combined with in every leprosy regimen it gives.", "cautions": [ "TREAT THROUGH THE NATIONAL PROGRAMME. Leprosy is notifiable and the regimen runs for a year or two; this is not a prescription to start and review in a fortnight.", "Rifampicin turns urine, tears and sweat orange, and stains soft contact lenses permanently. Warn the patient or they will stop the drug.", "It is a powerful enzyme inducer: it makes the combined oral contraceptive pill fail, and it lowers the level of many other drugs. Check every co-prescription.", "The formulary bars it in liver impairment, in jaundice from reduced bilirubin excretion, in premature and newborn infants, and in breastfeeding women, and it must not be combined with praziquantel, atazanavir, darunavir, fosamprenavir, ritonavir/saquinavir, saquinavir or tipranavir.", "Watch liver function. Hepatitis is the adverse effect that stops treatment." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric leprosy dose for rifampicin appears in the Egyptian formulary, because its rifampicin monograph does not cover leprosy at all. A child's regimen must come from the national leprosy programme.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "RIFAMPIN 300MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CAPS", "price_egp": 8.0, "pack_count": 10, "unit_price": 0.8, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFABIOTIC 300 MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 8.0, "pack_count": 8, "unit_price": 1.0, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMPICIN 300MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 9.5, "pack_count": 8, "unit_price": 1.19, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMPIN 300MG 8 CAPS (MISR)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 9.5, "pack_count": 8, "unit_price": 1.19, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIMACTANE 300MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS", "price_egp": 10.1, "pack_count": 8, "unit_price": 1.26, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMPIN 300MG 10 CAPS. (DEBEIKY)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY", "price_egp": 38.5, "pack_count": 10, "unit_price": 3.85, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFACTINE 300 MG 8 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 31.0, "pack_count": 8, "unit_price": 3.88, "strength_mg": 300.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAMOX 100MG/5ML 30GM SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "RIFAM 100MG/5ML 60ML SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 7.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "leprosy" }, { "id": 1111, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Chronic mycobacterial infection of skin and peripheral nerves. Egypt has reached WHO elimination thresholds but sporadic cases still occur, mostly in Upper Egypt/Delta foci, so a GP should recognise a suspicious hypopigmented anaesthetic patch or thickened nerve and refer to the national leprosy control programme, which supplies multidrug therapy free of charge rather than the GP prescribing it.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "Chronic mycobacterial infection of skin and peripheral nerves. Egypt has reached WHO elimination thresholds but sporadic cases still occur, mostly in Upper Egypt/Delta foci, so a GP should recognise a suspicious hypopigmented anaesthetic patch or thickened nerve and refer to the national leprosy control programme, which supplies multidrug therapy free of charge rather than the GP prescribing it.", "cautions": [ "Rare in Egyptian primary care.", "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.", "RED FLAG - Severe neuritis (leprosy immunologic reaction) is a medical emergency needing immediate corticosteroid treatment to prevent irreversible nerve damage.", "RED FLAG - Nerve abscess (most often the ulnar nerve) requires immediate surgical intervention to prevent irreversible sequelae.", "RED FLAG - An anaesthetic skin patch with a thickened peripheral nerve needs referral for a skin smear or biopsy, and sudden nerve pain or new weakness (a leprosy reaction or neuritis) needs urgent referral to prevent permanent nerve damage." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "leprosy" } ] }