2) Chemotherapy
Chair： Prof. J. Grosset
The participants in the workshop agreed to the following：
Because the global prevalence of leprosy has decreased dramatically, treatment delivery systems have to be adapted to the new reality, and it will be difficult to maintain everywhere the supervision of monthly doses of rifampicin. However because the present anti-leprosy drug regimens (WHO-recommended MDT) are so extremely effective and robust, these regimens should remain the treatment of choice for leprosy in national programmes. The robustness of the regimens and the systematic use of blister-packs enable less reliance on the direct supervision of monthly drug intake by the general health services.
Considering the effectiveness of the 2-year WHO-MDT for MDT leprosy, the changes in definition of PB and MB and the low BIs in the majority of MDT patients, short-ening the duration of treatment of MB leprosy to 12 months is justified. Similarly the use of single dose rifampicin - ofloxacin - minocycline (ROM) for the treatment of single lesion leprosy offers great operational advantage to national programmes. It should be understood that the current WHO recommendations represent minimal guidelines.
Except for the treatment of single lesion leprosy with ROM, use of the new drugs at the present time should be strictly limited to special circumstances, for example proven rifampicin resistance. The development of new drugs and regimens is encouraged and should continue to be a priority in the area of chemotherapy.
Drug resistance is not a problem at the current time and is not expected to increase in the future, even with shortening the duration of treatment of NO cases to 12 months, as long as the drugs are used in appropriate combinations. To replace mouse footpad inoculation, research should continue on molecular methods of detecting drug resistance.
Finally, it is crucially important for the survival of leprosy control programmes that the supply of drugs after the year 2000 be assured.
Participants：
Jacques Grosset, Chair, Scott Franzblau, Rapporteur, Robert Hastings, Paul Roche, D. V. A. Opromolla, BaohongJi, Lou Levy, Diana Williams.
J. Grosset, Faculte de Medecine, Pitie-Salpetriere, Paris, FRANCE
