Negligible risk of inducing resistance in Mycobacterium tuberculosis with single-dose rifampicin as post-exposure prophylaxis for leprosy.
Post-exposure prophylaxis (PEP) for leprosy is administered as one single dose of rifampicin (SDR) to the contacts of newly diagnosed leprosy patients. SDR reduces the risk of developing leprosy among contacts by around 60 % in the first 2-3 years after receiving SDR. In countries where SDR is currently being implemented under routine programme conditions in defined areas, questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M. tuberculosis strains circulating in these areas. This issue has not been addressed in scientific literature to date. To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis, a meeting was convened with tuberculosis (TB) and leprosy experts. The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of (multi) drug-resistance in M. tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy. They concluded that SDR given to contacts of leprosy patients, in the absence of symptoms of active TB, poses a negligible risk of generating resistance in M. tuberculosis in individuals and at the population level. Thus, the benefits of SDR prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M. tuberculosis.
Netherlands Leprosy Relief, P.O. Box 95005, 1090 HA, Amsterdam, The Netherlands. L.Mieras@Leprastichting.nl.
Liesbeth
L
Mieras
Royal Tropical Institute (KIT), Amsterdam, The Netherlands.
Richard
R
Anthony
Netherlands Leprosy Relief, P.O. Box 95005, 1090 HA, Amsterdam, The Netherlands.
Wim
W
van Brakel
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Martin W
MW
Bratschi
Independent TB and Leprosy Consultant, Helmond, The Netherlands.
Jacques
J
van den Broek
French National Reference Center for Mycobacteria, Paris, France.
Emmanuelle
E
Cambau
Novartis Foundation, Basel, Switzerland.
Arielle
A
Cavaliero
The German Leprosy and Tuberculosis Relief Association, Würzburg, Germany.
Christa
C
Kasang
Ministry of Health, Colombo, Sri Lanka.
Geethal
G
Perera
New Jersey Medical School Global Tuberculosis Institute, New Jersey, USA.
Lee
L
Reichman
Erasmus MC, Rotterdam, The Netherlands.
Jan Hendrik
JH
Richardus
American Leprosy Missions, Greenville, USA.
Paul
P
Saunderson
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Peter
P
Steinmann
Chinese University of Hong Kong, Hong Kong, China.
Wing Wai
WW
Yew
D024881:Drug Resistance, Bacterial; D006801:Humans; D007917:Leprostatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007918:Leprosy / Q000188:drug therapy*; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D056990:Post-Exposure Prophylaxis; D012293:Rifampin / Q000494:pharmacology* / Q000627:therapeutic use*; D012306:Risk; D018088:Tuberculosis, Multidrug-Resistant / Q000382:microbiology*
D007917:Leprostatic Agents; D012293:Rifampin
Leprosy; Mycobacterium tuberculosis; Post-exposure prophylaxis; Rifampicin resistance