Hansen's Disease (Leprosy)

Current and Future Pharmacotherapy and Treatment of Disease-related Immunologic Reactions

Davey P. Legendre, Pharm.D.; Christina A. Muzny, M.D.; Edwin Swiatlo, M.D., Ph.D.

Pharmacotherapy. 2012;32(1):27-37.

Clarithromycin

Clarithromycin is a semisynthetic macrolide antibiotic with bactericidal activity against M. leprae greater than other macrolides although less bactericidal than minocycline.^[54] Its mechanism may be due to reduction of ATP in the bacteria.^[57] It is useful as an alternative to primary therapy due to either resistance or intolerance and has been used to treat lepromatous leprosy as monotherapy with success, although higher doses lead to some gastrointestinal distress.^[58] Clarithromycin 500 mg/day has been paired successfully with minocycline.^[56]

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Table 1. Recommended Therapy According to the World Health Organization ³³ and the National Hansen's Disease Program ³⁴
WHO Classification of Disease	NHDP Recommendation	WHO Recommendation
Single-lesion paucibacillary	Dapsone 100 mg/day + rifampin 600 mg/day for 12 mo	Rifampin 600 mg once + ofloxacin 400 mg once + minocycline 100 mg oncea
Paucibacillary	Dapsone 100 mg/day + rifampin 600 mg/day for 12 mo	Dapsone 100 mg/day (unsupervised) + rifampin 600 mg/mo (supervised) for 6 mo
Multibacillary	Dapsone 100 mg/day + rifampin 600 mg/day + clofazimine 50 mg/day for 24 mo	Dapsone 100 mg/day (unsupervised) + rifampin 600 mg/mo (supervised) + clofazimine 300 mg/mo (supervised) for 24 mo

WHO = World Health Organization; NHDP = National Hansen's Disease Program.
^aThis regimen is not recommended in the United States and is associated with clinical failure.

Table 2. Pharmacokinetic Properties of Antibacterials ^36-38
Antibacterial	Bioavailability (%)	Half-Life (hrs)	Metabolism	Route of Elimination
Dapsone	80–99	30	Acetylation	20% urine
Rifampin	60–99^a	3–5	Deacetylation	60% feces, 30% urine
Clofazimine	20–70^b	70 days	Not available	Feces
Ofloxacin	98	4–8	Hepatic	95% urine, 5% feces
Moxifloxacin	86	15	Glucoronidation, sulfation	20% urine, 25% feces
Minocycline	100	14–18	Hepatic	20% urine
Clarithromycin	55	3	Hepatic	30% urine

^aFood decreases absorption.
^bFood increases absorption.

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