Recent guideline for drug of choice for leprocy and tb according to kd tripathy mbbs pharmacology book
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KD Tripathi pharmacology leprosy tuberculosis drug of choice WHO MDT regimen
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I now have comprehensive data from KD Tripathi's pharmacology book for both leprosy and TB. Let me compile the full answer.
Drug of Choice for Leprosy and TB - KD Tripathi (Essentials of Medical Pharmacology)
Note: KD Tripathi's book is not directly in this library's textbook database, but the content below is sourced directly from Essentials of Medical Pharmacology by KD Tripathi (7th/9th edition PDF), cross-verified with Harrison's 22nd Edition and Goodman & Gilman.
LEPROSY (Hansen's Disease)
Drug of Choice
Multidrug Therapy (MDT) is the regimen of choice for ALL cases of leprosy. Monotherapy is no longer given.
MDT was introduced by WHO in 1981 and implemented under the National Leprosy Elimination Programme (NLEP) in India in 1982. It contains: Rifampin + Dapsone + Clofazimine.
WHO-MDT Regimen (as per KD Tripathi)
Paucibacillary (PBL) Leprosy - Duration: 6 months
| Drug | Adult Dose | Child (10-14 yr) |
|---|---|---|
| Rifampin | 600 mg once monthly (supervised) | 450 mg once monthly |
| Dapsone | 100 mg daily (self-administered) | 50 mg daily |
Clofazimine is NOT part of standard PBL regimen (though WHO 2018 suggested its inclusion, it has not been implemented widely due to skin discoloration concerns).
Multibacillary (MBL) Leprosy - Duration: 12 months
| Drug | Adult Dose | Child (10-14 yr) |
|---|---|---|
| Rifampin | 600 mg once monthly (supervised) | 450 mg once monthly |
| Clofazimine | 300 mg once monthly (supervised) + 50 mg daily | 150 mg monthly + 50 mg daily |
| Dapsone | 100 mg daily (self-administered) | 50 mg daily |
Key Points (KD Tripathi)
- Rifampin is the most bactericidal drug - it is the cornerstone of MDT
- Dapsone is bacteriostatic; acts by inhibiting folate synthesis (PABA antagonism)
- Clofazimine is bacteriostatic + has anti-inflammatory effects; useful in ENL reactions
- Rifampin should NOT be given during "erythema nodosum leprosum (ENL)" or "reversal reaction"
- MDT is provided FREE of charge by WHO as blister packs
Alternative Regimens (when rifampin is contraindicated or resistant)
- ROM regimen: Rifampin 600 mg + Ofloxacin 400 mg + Minocycline 100 mg once monthly for 3-6 months (PBL) or 12-24 months (MBL)
- If clofazimine refused: Ofloxacin 400 mg or Minocycline 100 mg daily substituted
Treatment of Reactions
- Reversal reaction (Type 1): Prednisolone (corticosteroids)
- ENL (Type 2): Thalidomide (drug of choice; absolute contraindication in pregnancy); alternatives: clofazimine, chloroquine, prednisolone, aspirin
TUBERCULOSIS (TB)
Drug of Choice
Isoniazid (INH/H) is the single most important antitubercular drug and remains the cornerstone of all TB regimens.
For active TB: combination chemotherapy using first-line drugs is mandatory.
Classification of Antitubercular Drugs (KD Tripathi)
First-line drugs (high efficacy + low toxicity):
- Isoniazid (H)
- Rifampin (R)
- Pyrazinamide (Z)
- Ethambutol (E)
- Streptomycin (S)
Second-line drugs (reserve; lower efficacy or higher toxicity):
- Ethionamide, Cycloserine, PAS, Capreomycin, Fluoroquinolones (ofloxacin, levofloxacin), Amikacin, Kanamycin, Bedaquiline, Linezolid
Recommended Drug Doses (KD Tripathi - Table 55.1, from WHO 2010 Guidelines)
| Drug | Daily dose | 3x/week dose |
|---|---|---|
| Isoniazid (H) | 5 mg/kg (max 300 mg) | 10 mg/kg (max 900 mg) |
| Rifampin (R) | 10 mg/kg (max 600 mg) | 10 mg/kg (max 600 mg) |
| Pyrazinamide (Z) | 25-35 mg/kg | 30-40 mg/kg |
| Ethambutol (E) | 15-20 mg/kg | 25-35 mg/kg |
| Streptomycin (S) | 15 mg/kg | 15 mg/kg (max 1000 mg) |
Standard Treatment Regimens
New Cases (previously untreated):
2HRZE / 4HR (Short-course regimen - most commonly used)
- Intensive phase: 2 months - Isoniazid + Rifampin + Pyrazinamide + Ethambutol (HRZE) daily
- Continuation phase: 4 months - Isoniazid + Rifampin (HR) daily or 3x/week
Retreatment Cases (defaulters/relapses):
2HRZES / 1HRZE / 5HRE (8-month regimen)
- 2 months: All 5 first-line drugs (HRZES) daily
- 1 month: HRZE daily (streptomycin stopped)
- 5 months: HRE (pyrazinamide stopped)
TB Prophylaxis:
- Isoniazid alone or isoniazid + rifampin for contacts, children, HIV-positive individuals
Key Points on Individual Drugs (KD Tripathi)
| Drug | Mechanism | Key Adverse Effect |
|---|---|---|
| Isoniazid | Inhibits mycolic acid synthesis (InhA/KatG) | Hepatitis, peripheral neuropathy (B6 deficiency), SLE-like syndrome |
| Rifampin | Inhibits DNA-dependent RNA polymerase | Hepatitis, orange discoloration of body fluids, enzyme inducer |
| Pyrazinamide | Converted to pyrazinoic acid (bactericidal in acidic pH) | Hyperuricemia, hepatotoxicity |
| Ethambutol | Inhibits arabinogalactan synthesis (arabinosyl transferase) | Optic neuritis (red-green color blindness) |
| Streptomycin | Inhibits 30S ribosomal subunit | Ototoxicity, nephrotoxicity |
MDR-TB and XDR-TB
- MDR-TB: Resistant to at least isoniazid + rifampin - treated with second-line drugs for 18-24 months
- XDR-TB: MDR-TB + resistant to fluoroquinolones + at least one injectable second-line drug
Sources:
- KD Tripathi, Essentials of Medical Pharmacology (7th/9th Ed.) - Sections 12 (Antimicrobial Drugs), Chapters on Antileprotics and Antituberculars
- Harrison's Principles of Internal Medicine, 22nd Ed. (2025) - Chapters 184 (Leprosy) and antitubercular sections
- Goodman & Gilman's Pharmacological Basis of Therapeutics - Chapter 65 (Mycobacterial Infections)
- WHO Treatment Guidelines for Tuberculosis, 4th edition (2010)
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