DRUGS for LEPROSY 

CHAULMOOGRA OIL

The writings of Susruta, of about 600BC, refers to leprosy being treated with chaulmoogra oil from the seeds of a coconut-shaped fruit of the Hydnocarpus tree(1). This plant based treatment was amongst those included in the `Ayurveda` of about 500BC. In the 12thC AD, chaulmoogra oil was imported into China from Cambodia - the native "home" of the tree from which it is derived(2).

Although the oil had been given orally to leprosy patients for centuries, one of the problems with it being administered in this way was its nauseating taste(3). To try and overcome this, the oil was given in capsule form- with a dosage of 0.25-0.5ml being increased to 4ml(4).

In 1907, workers in San Lazaro found that mixing the oil with camphor rendered it sufficiently absorbable to allow for it to be given by hypodermic syringe. Workers in India made improvements soon after 1915(5) and this form of treatment continued until the 1940s(6).

Much later, animal experiments showed that oral doses of 5ml/kg (far in excess of the prescribed dose used in human leprosy patients) and intraveneous injections of 0.5ml/kg caused death in rabbits(7). 

refs

1. Skillcorn,R. Skillcorn,K www.webspanner.com/users/LEPROSY

2. Steger,JW. Barrett,TL. Textbook of Military Medicine - Military Dermatology. 1994. (on www.vhn.org/MilitaryDerm/Ch14.pdf)

3. Heiser,V. An American Doctor`s Odyssey. WW Norton & Co. 1936.

4. British Pharmaceutical Codex. 1911.

5. Heiser,V. An American Doctor`s Odessey. WW Norton & Co. 1936.

6. American Leprosy Missions website (on www.christianity.com)

7. Gosselin,RE et al [eds]. Clinical Toxicology of Commercial Products. Williams & Wilkins.

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  SULPHANILAMIDE

In 1940, at the US National Leprosarium, Carville, Louisiana, the antibiotic, sulphanilamide, was given to leprosy patients - but little or no imrovement was noted in the leprous lesions(1).

  PROMIDE

Changes to the chemical structure of sulphanilamide resulted in promide, which underwent clinical trials in 1938, before being used on the first group of leprosy patients at the National Leprosarium in March 1941. Two years later, reports were made of the treatment being of benefit(2) - but required numerous injections(3).

  DAPSONE

In the 1940s, without the use of animal experimentation, sulfones were shown to be effective against leprosy bacillus(4). Following the discovery of diamino dypheryl sulphone - dapsone DDS, Robert Cochrane successful treated leprosy patients with the new drug in an oily suspension which was administered intramuscularly. A year later, Lowe gave dapsone orally to patients. For almsot 30 years, dapsone was the main drug used in the treatment of leprosy(5). But during the 1950s, the leprosy bacillus began to develop resistance to dapsone(6).

  CLOFAZAMINE

In the 1960s another drug, clofazamine, became available. In 1962, Brown and Hogenzeil first used it clinically in Nigeria with encouraging results(7).

ref

1. Steger,JW. Barrett,TL. Textbook of Military Medicine - Military Dermatology. 1994. (on www.vhn.org/MilitaryDerm/Ch14.pdf)

2. Steger,JW. Barrett,TL. Textbook of Military Medicine - Military Dermatology. 1994. (on www.vhn.org/MilitaryDerm/Ch14.pdf)

3. American Leprosy Missions website (on www.christianity.com)

4. Beddow-Baylet,M. Clinical Medical Discoveries. NAVS. 1961.

5. Steger,JW. Barrett,TL. Textbook of Military Medicine - Military Dermatology. 1994. (on www.vhn.org/MilitaryDerm/Ch14.pdf)

6. American Leprosy Missions website(on www.christianity.com)

7. Skillcorn,R. Skillcorn,K www.webspanner.com/users/LEPROSY

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  MULTI-DRUG THERAPY

Combination drug therapy had been in use since 1981, when the World Health Organisation recommended Multi-Drug Therapy - consisting of dapsone, clofazamine, and rifampicin(1). The latter was subjected to animal tests. Doses of 20mg/kg killed about 99% of viable leprosy baccilli induced in the foot pads of mice. Animal tests also showed that the drug also induced the metabolism of dapsone - but this was considered of little importance in its forthcoming clinical use(2).  It should also be noted that when dapsone had been used clinically as a single drug, it did not actually kill the bacillus but only prevented its multiplication(3). After clinical trials, WHO recommended that the standard treatment for multibacterial leprosy should consist of 600mg of rifampin once a month, 100mg of dapsone daily, 300mg of clofazimine once a month(3).

refs

1. Steger,JW. Barrett,TL. Textbook of Military Medicine - Military Dermatology. 1994. (on www.vhn.org/MilitaryDerm/Ch14.pdf)

2. Skillcorn,R. Skillcorn,K www.webspanner.com/users/LEPROSY

3. Steger,JW. Barrett,TL. Textbook of Military Medicine - Military Dermatology. 1994. (on www.vhn.org/MilitaryDerm/Ch14.pdf)