{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T11:09:08Z","timestamp":1768820948992,"version":"3.49.0"},"reference-count":25,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,1,9]]},"abstract":"<jats:p>A subset of multibacillary (MB) leprosy patients manifest with clinical \u201cnonresponsiveness\u201d to the fixed-duration, World Health Organization multidrug therapy MB regimen (WHO-MDT-MBR). The aim of this retrospective study was to assess the effectiveness and safety of alternate anti-leprosy therapy (ALT) in such patients. This is an analysis of patients\u2019 records, registered in the leprosy clinic of our institute over a period of 6 years (2010\u20132015). The criteria for inadequate response\/nonresponsiveness to treatment were as follows: 1) persistent\/new lesions after completing \u2265 12 months of WHO-MDT-MBR (isolated reactions were ruled out histopathologically) and 2) persistent positive\/increasing value of the morphological index (MI) and a 2 log increase in the bacteriological index (BI) after \u2265 12 months of WHO-MDT-MBR. Such cases were treated with ALT consisting of minocycline, clofazimine, and ofloxacin (24 months). Of 556 patients registered during the study period, 40.3% (224) were slit-skin smear (SSS) positive and 59.7% (332) were SSS negative. Of all, 35 patients (6.3%) satisfied the criteria for clinical nonresponsiveness. Of 224 SSS-positive patients, these 35 patients amounted to 15.6%. The mean BI and MI of these patients after completion of \u2265 12 months of WHO-MDT-MBR were 5.3 \u00b1 0.6 and 14 \u00b1 6.8%, respectively. After 6 months of treatment with ALT, MI became negative (0) in all these patients. After completion of ALT, the mean BI and MI became 1.7 \u00b1 0.7 and 0%, respectively (<jats:italic>P<\/jats:italic> &lt; 0.0001). There were 16 patients with corticosteroid-dependent recurrent\/chronic erythema nodosum leprosum, who had excellent response with significant reduction in the number of reactional episodes and mean dose of prednisolone required (<jats:italic>P<\/jats:italic> &lt; 0.0001). No serious adverse effects were noted. We conclude that ALT is safe and effective in the management of MB leprosy patients who are nonresponsive to 12 months of WHO-MDT-MBR.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0256","type":"journal-article","created":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T07:07:09Z","timestamp":1539068829000},"page":"24-30","source":"Crossref","is-referenced-by-count":27,"title":["Alternate Anti-Leprosy Regimen for Multidrug Therapy Refractory Leprosy: A Retrospective Study from a Tertiary Care Center in North India"],"prefix":"10.4269","volume":"100","author":[{"given":"Tarun","family":"Narang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuradha","family":"Bishnoi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil","family":"Dogra","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uma Nahar","family":"Saikia","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Kavita","sequence":"additional","affiliation":[{"name":"National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"e293","article-title":"Multidrug therapy for leprosy: a game changer on the path to elimination","volume":"17","author":"Smith","year":"2017"},{"key":"b2","series-title":"Wkly Epidemiol Rec","first-page":"501","article-title":"Global leprosy update, 2016: accelerating reduction of disease burden","volume":"92","author":"World Health Organization","year":"2017"},{"key":"b3","series-title":"Clin Exp Dermatol","first-page":"908","article-title":"Drug resistance in Mycobacterium leprae from patients with leprosy in China","volume":"40","author":"Liu","year":"2015"},{"key":"b4","series-title":"J Clin Microbiol","first-page":"4359","article-title":"Identification of primary drug resistance to rifampin in Mycobacterium leprae strains from leprosy patients in Amazonas state, Brazil","volume":"52","author":"Contreras Mejia Mdel","year":"2014"},{"key":"b5","series-title":"Lepr Rev","first-page":"177","article-title":"Drug resistance patterns in Mycobacterium leprae isolates from relapsed leprosy patients attending the leprosy mission (TLM) hospitals in India","volume":"85","author":"Lavania","year":"2014"},{"key":"b6","series-title":"Clin Microbiol Infect","first-page":"e85","article-title":"Emergence of primary drug resistance to rifampicin in Mycobacterium leprae strains from leprosy patients in India","volume":"21","author":"Lavania","year":"2015"},{"key":"b7","series-title":"WHO Expert Committee on Leprosy: Eighth Report. 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