NCLEX : Antimicrobial Pharmacology

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Example Question #41 : Antimicrobial Pharmacology

A 42-year-old immigrant from Pakistan comes to your office after his wife noted hypopigmented anesthetic patches on his back. On further examination, you discover bilaterally thickened ulnar nerves. Skin biopsy reveals numerous acid-fast bacilli and a negative lepromin test. What combination of drugs would you recommend for this patient?

Possible Answers:

Dapsone, Clofazimine, Ethambutol

Isoniazid, Rifampin, Dapsone

Pyrazinamide, Rifampin, Isoniazid

Dapsone, Clofazimine, Rifampin

Ethambutol, Isoniazid, Clofazimine

Correct answer:

Dapsone, Clofazimine, Rifampin

Explanation:

Leprosy is of two types namely lepromatous and tuberculoid.This patient is suffering from lepromatous leprosy on account of the symmetric nerve involvement, the abundant acid fast bacilli and the negative lepromin test. The course of this subtype is progressive and malignant. In case of tuberculoid leprosy the course is more benign with cellular immunity remaining intact. The skin biopsy shows few bacilli and there is a positive skin test. Combination therapy is recommended for all types of leprosy to avoid the emergence of resistance. Cases of lepromatous leprosy are treated with a combination therapy involving the use of the following:

  • Dapsone
  • Rifampin
  • Clofazimine

This combination is given for 2 to 3 years, ideally till the skin biopsies are negative. Cases of indeterminate (borderline) and tuberculoid leprosy are treated with a combination therapy involving the use of the following:

  • Dapsone
  • Rifampin 

Rifampin for 6 to 12 months followed by dapsone—alone—for 2 years.

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