Treatment of Leprosy with Resistance to Both Rifampicin and Ofloxacin

Confirmed resistance to both rifampicin and ofloxacin rules out the standard multidrug regimen and requires a specifically structured alternative protocol. The resistance profile directly shapes which agents can be used and which must be avoided entirely.

Clinical scenario: Leprosy in a patient with demonstrated resistance to both rifampicin and ofloxacin. Because ofloxacin resistance is confirmed, a fluoroquinolone must not be included in the treatment regimen.

Treatment approach: Management involves a combination of specific antibiotics delivered across two sequential phases — with fluoroquinolones excluded throughout. The complete drug selection, phase structure, and full course duration are detailed in the protocol.

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References

Leprosy patients with resistance to both rifampicin and ofloxacin may be treated with the following drugs: clarithromycin, minocycline and clofazimine for 6 months followed by clarithromycin or minocycline plus clofazimine for an additional 18 months.
When ofloxacin resistance is also present, a fluoroquinolone should not be used as part of second-line treatment.
The regimen of choice in such cases shall consist of 6 months of clarithromycin, minocycline and clofazimine followed by clarithromycin or minocycline plus clofazimine for an additional 18 months.

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