Paper II
Question
(
- (a) Discuss the First Line Drugs used in Leprosy with dosage. ( 4 mark(s)
- (b) Discuss the management of Invasive intestinal Amoebiasis. 4 mark(s)
Answer
a) First-line drugs in leprosy, with dosage Standard multidrug therapy (MDT) uses three drugs — Dapsone, Rifampicin, Clofazimine — combined for the same resistance-prevention rationale as antitubercular therapy.
- Paucibacillary leprosy (tuberculoid, low bacterial load): Rifampicin 600 mg once monthly (supervised) + Dapsone 100 mg daily (self-administered), for 6 months.
- Multibacillary leprosy (lepromatous, high bacterial load): Rifampicin 600 mg once monthly + Dapsone 100 mg daily + Clofazimine 300 mg once monthly (supervised) and 50 mg daily (self-administered), for 12 months.
The added third drug and longer duration in multibacillary disease reflect the larger bacterial burden and correspondingly higher risk of spontaneous resistant mutants.
b) Management of invasive intestinal amoebiasis
- Tissue amoebicide: Metronidazole or Tinidazole — nitroimidazoles active against invasive trophozoites in the intestinal wall, the mainstay of treatment for symptomatic invasive disease (amoebic dysentery).
- Luminal amoebicide: given after the tissue amoebicide course to eradicate residual gut cysts and prevent relapse/transmission — Diloxanide furoate or Paromomycin.
- Supportive care: fluid and electrolyte replacement for dysentery-associated losses.
- Surgical intervention reserved for rare complications (perforation, toxic megacolon) unresponsive to medical therapy.