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Emerging antimicrobial resistance in leprosy
Why it is in news?
- A six-year study carried out across 19 countries has now shown that antimicrobial resistance is emerging in leprosy cases. This global data shows that a total of 8% of the Mycobacterium leprae bacterial strains studied showed gene mutations conferring resistance towards drugs such as rifampicin, dapsone and ofloxacin.
- Rifampicin resistance was observed in about 5% of the relapse cases and in 2% of the new ones. India and Brazil topped the list with more than 10 rifampicin-resistant cases each.
Methods for Assessing antimicrobial resistance
- Assessing antimicrobial resistance has not been possible so far as M. leprae does not grow in vitro.
- Currently, there are only two techniques for studying M. leprae - the mouse foot-pad technique and genetic analysis.
- As the former is time-consuming, molecular methods for detecting the resistance genes is widely used.
Rifampicin and Dapsone resistance
- Global data showed that among the 1,932 (1,143 relapse and 789 new) cases studied, 3.8% showed gene mutations showing resistance to rifampicin. The number was 4.5% for dapsone and 1.1% for ofloxacin.
- Certain cases showed resistance to more than one drug. Globally, 20 cases showed rifampicin and dapsone resistance, four showed ofloxacin and dapsone resistance.
- Interestingly there were no cases of resistance to rifampicin and ofloxacin together. More studies are needed to know in depth about this.
- In India, the study was carried out in five laboratories across the country. Among the 382 cases studied from India, 4.7% showed resistance to rifampicin, 6.4% dapsone resistant and 4.4% ofloxacin resistant.
Way ahead
- Now, with the emergence of antimicrobial resistance, it also stresses the need for immediate notice, routine investigation and establishment of proper treatment guidelines by the government.
- Unlike the routine regime (rifampicin, dapsone and clofazimine) administered once a month and given free of cost, the alternative drug regime (minocycline and ofloxacin) given to drug-resistant patients is a daily dose, prescribed for two years, and is very expensive. The government,currently, has no provision to provide this free of cost. So,its need of hour to focus on it and making provisions for the same.