Negligible risk of inducing resistance in Mycobacterium tuberculosis with single-dose rifampicin as post-exposure prophylaxis for leprosy

Liesbeth MierasEmail author,
Richard Anthony,
Wim van Brakel,
Martin W. Bratschi,
Jacques van den Broek,
Emmanuelle Cambau,
Arielle Cavaliero,
Christa Kasang,
Geethal Perera,
Lee Reichman,
Jan Hendrik Richardus,
Paul Saunderson,
Peter Steinmann and
Wing Wai Yew

Infectious Diseases of Poverty20165:46

DOI: 10.1186/s40249-016-0140-y

Received: 22 January 2016

Accepted: 28 April 2016

Published: 8 June 2016

Abstract

Post-exposure prophylaxis (PEP) for leprosy is administered as one single dose of rifampicin (SDR) to the contacts of newly diagnosed leprosy patients. SDR reduces the risk of developing leprosy among contacts by around 60 % in the first 2–3 years after receiving SDR. In countries where SDR is currently being implemented under routine programme conditions in defined areas, questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M. tuberculosisstrains circulating in these areas. This issue has not been addressed in scientific literature to date. To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis, a meeting was convened with tuberculosis (TB) and leprosy experts. The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of (multi) drug-resistance in M. tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy. They concluded that SDR given to contacts of leprosy patients, in the absence of symptoms of active TB, poses a negligible risk of generating resistance in M. tuberculosis in individuals and at the population level. Thus, the benefits of SDR prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M. tuberculosis.