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The main aim of treatment is to kill <jats:italic>Mycobacterium leprae<\/jats:italic> and decrease the bacterial load, which could help prevent further bacilli transmission. A major concern in breaking the chain of transmission and possibly for recurrent reactions is the role\u00a0of drug\u2010resistant bacilli. Though some data is available on the background prevalence of drug resistance in leprosy, there is a paucity of studies that look for resistance specifically in leprosy reactions. Administration of long\u2010term steroids or immunosuppressants for chronic and recurrent responses in the presence of drug resistance has the twin effect of perpetuating the multiplication of resistant bacilli and encouraging the dissemination of leprosy. The increasing trend of prescribing second\u2010line drugs for leprosy or type 2 reactions without prior assessment of drug resistance can potentially precipitate a severe public health problem as this can promote the development of resistance to second\u2010line drugs as well. A comprehensive multicenter study, including drug resistance surveillance testing in cases of reactions, is necessary, along with the current measures to stop the spread of leprosy. Here, we have detailed the history of drug resistance in leprosy, given pointers on when to suspect drug resistance, described the role of resistance in reactions, methods of resistance testing, and the management of resistant cases with second\u2010line therapy.<\/jats:p>","DOI":"10.1111\/ijd.17470","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T13:08:51Z","timestamp":1726060131000},"page":"302-312","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Implications of drug resistance in leprosy: disease course, reactions and the use of novel drugs"],"prefix":"10.1111","volume":"64","author":[{"given":"Kabir","family":"Sardana","sequence":"first","affiliation":[{"name":"Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aishwarya","family":"Muddebihal","sequence":"additional","affiliation":[{"name":"Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Scollard","sequence":"additional","affiliation":[{"name":"National Hansen's Disease Program  Baton Rouge LA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7020-7777","authenticated-orcid":false,"given":"Ananta","family":"Khurana","sequence":"additional","affiliation":[{"name":"Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,9,11]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"World Leprosy Day 2021(cited 13 September 2021). 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