Leprosy with Rifampicin Resistance and No Ofloxacin Resistance

This protocol addresses patients with confirmed rifampicin-resistant leprosy in whom ofloxacin resistance has been ruled out. The resistance profile determines which second-line agents remain available, and appropriate drug selection is critical to treatment success.

Clinical Situation

Rifampicin is the cornerstone of standard leprosy multidrug therapy. When resistance to rifampicin is confirmed, the treatment regimen must be restructured around alternative agents. In this scenario, ofloxacin resistance is absent, which preserves the full range of quinolone options as part of the second-line strategy.

Treatment Approach

Management involves a structured combination of second-line antimicrobial agents — selected from specific drug classes — together with a companion drug administered over an extended, phased course. The precise combination, sequencing, and duration of therapy are defined in the full evidence-based protocol.

Full regimen details, sequencing, and clinical decision points available via the protocol →

Instant Access to Structured Evidence-Based Regimens

References

Leprosy patients with rifampicin resistance may be treated using at least two of the following second-line drugs: clarithromycin, minocycline or a quinolone (ofloxacin, levofloxacin or moxifloxacin), plus clofazimine daily for 6 months, followed by clofazimine plus one of the second-line drugs daily for an additional 18 months.
When ofloxacin resistance is also present, a fluoroquinolone should not be used as part of second-line treatment.
For rifampicin-resistant leprosy, the guidelines recommend treatment with at least two second-line drugs (clarithromycin, minocycline or a quinolone) plus clofazimine daily for 6 months, followed by clofazimine plus one of these drugs for an additional 18 months.

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