Treatment of leprosy in children

National Hansen's Disease Program (NHDP)*			World Health Organization 2018 (WHO)^[1]
Regimen	Dose	Duration	Regimen	Dose for children 10 to 14 years	Dose for children <10 years or <40 kg	Duration
Tuberculoid ("paucibacillary"): TT, BT			Tuberculoid ("paucibacillary"): TT, BT
Dapsone^¶	1 mg/kg once daily (not to exceed 100 mg/day)	12 months	Dapsone^¶	50 mg once daily	2 mg/kg once daily	6 months
Rifampin^¶	10 to 20 mg/kg once daily (not to exceed 600 mg/day)	12 months	Rifampin^¶	450 mg once monthly	10 mg/kg once monthly
			Clofazimine^Δ	150 mg once monthly, and 50 mg on alternate days	100 mg once monthly, and 50 mg twice weekly
Lepromatous ("multibacillary"): LL, BL, BB			Lepromatous ("multibacillary"): LL, BL, BB
Dapsone^¶	1 mg/kg once daily (not to exceed 100 mg/day)	24 months	Dapsone^¶	50 mg once daily	2 mg/kg once daily	12 months
Rifampin^¶	10 to 20 mg/kg once daily (not to exceed 600 mg/day)		Rifampin^¶	450 mg once monthly	10 mg/kg once monthly
Clofazimine^Δ	1 mg/kg once daily (not to exceed 50 mg daily)		Clofazimine^Δ	150 mg once monthly, and 50 mg every other day	100 mg once monthly, and 50 mg twice weekly

TT: tuberculoid; BT: borderline tuberculoid; LL: lepromatous; BL: borderline lepromatous; BB: mid-borderline (these refer to the Ridley-Jopling classification).

* The NHDP follows the WHO guidance issued in 1982, which favors a longer duration of therapy, administration of rifampin daily rather than monthly, and excludes clofazimine for treatment of paucibacillary disease. Additional information is available at the NHDP website: http://www.hrsa.gov/hansensdisease/diagnosis/recommendedtreatment.html.

¶ Oral suspension may be compounded. Refer to the Lexicomp pediatric drug information on extemporaneous preparations.

Δ As there is no formulation of clofazimine less than 50 mg and the capsule should never be cut open, alternate-day dosing (2 mg/kg every other day) may be used. Clofazimine should be taken either with or immediately after food or milk to facilitate absorption. In the United States, the NHDP holds the Investigational New Drug (IND) for clofazimine treatment of leprosy. For further information or to request investigator status to use clofazimine, contact the NHDP: 1-800-642-2477.

Reference:

WHO Guidelines for the Diagnosis, Treatment, and Prevention of Leprosy (2018). https://www.who.int/publications/i/item/9789290226383 (Accessed January 5, 2023).

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Treatment of leprosy in children