While single dose rifampicin as PEP gives a risk reduction of around 60% when given to contacts of leprosy patients, the PEP++ regimen seeks a risk reduction of 80 – 90%. Besides the bactericidal, sterilising and bacteriostatic activity of the possible drugs, the safety, acceptability, availability, feasibility, affordability and risk of drug resistance were considered. The expert meeting recommended a combination of moxifloxacin and rifampicin in three doses with an interval of one month between doses. The effectiveness of this ‘PEP++ regimen’ will be determined and compared to SDR-PEP in the ‘PEP++ project’.
Preventing new cases
It is well known that contacts of (former) leprosy patients have a higher risk of developing leprosy as they are more likely to have been exposed to the bacteria. Providing post-exposure prophylaxis (PEP) to these contacts will reduce their risk to develop the disease and will contribute to stopping the transmission of leprosy by preventing new cases. Several chemoprophylactic regimens have demonstrated to be effective in contacts, including single dose rifampicin (SDR), which reduces the risk by 60%. Preliminary results of the LPEP project also show that the level of acceptance of SDR-PEP among contacts is very high and the integration of SDR-PEP in routine leprosy control is feasible. A likely reason for its limited effectiveness to date is that a single dose is insufficient to prevent manifestations of the disease in those that have advanced subclinical infection. Therefore, a more potent antibiotic or regimen is needed as chemoprophylaxis to prevent new cases among the closest, mostly household, contacts.