Field application of combined therapy for infectious leprosy cases. A feasibility study in Bombay

The practical problems related to dapsone monotherapy for a prolonged period to infectious leprosy patients are well known to the scientific community and combined treatment of dapsone with clofazimine, rifampicin or prothionamide has been successfully carried out by several workers in hospitalised leprosy patients. The application of polytherapy in field condition was hindered by the cost of the drugs and fear of side effects. 42 infectious leprosy patients attending 5 field leprosy clinics in the slums of Bombay city were put on combined drug schedule. The drug compliance of these patients was judged along with their regularity in attendance at clinics by the persons in charge and periodic and frequent check up of urines. 27 (65%) were regular in treatment from the beginning, 8(19%) who were initially irregular after motivation and 7(17%) remained irregular through out the period. The urine samples collected from leprosy patients on monotherapy and attending the same centres revealed 31% irregularity in drug consumption. The study indicates that advocating combined therapy in field conditions by paramedical workers is quite feasible. The patients on multiple drugs are more regular in drug consumption as compared to monotherapy group. The frequent check up of urine for drug content and advice to patients who are irregular in treatment improve their regularity in drug consumption.