Multibacillary leprosy — DTM&H MCQ
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Correct answer: C — Multidrug therapy with rifampicin, dapsone and clofazimine
The correct answer is C, multidrug therapy with rifampicin, dapsone and clofazimine. This man has multibacillary leprosy (Hansen's disease), evidenced by multiple hypopigmented anaesthetic patches, thickened ulnar nerves, ulnar-innervated intrinsic hand weakness (finger abduction), and a positive slit-skin smear for acid-fast bacilli (Mycobacterium leprae). A positive smear confirms high bacillary load, placing him in the multibacillary category, which requires triple therapy for 12 months rather than the paucibacillary two-drug, 6-month regimen. Rifampicin provides rapid bactericidal killing, dapsone adds further antimicrobial activity, and clofazimine both kills M. leprae and has anti-inflammatory properties that reduce the risk of leprosy reactions. Nerve function assessment and steroid cover for neuritis run alongside MDT to limit permanent disability such as claw hand. Why the other options are wrong: B. Praziquantel and albendazole: these treat schistosomiasis and soil-transmitted helminths or neurocysticercosis, not a mycobacterial infection, and have no activity against M. leprae. E. Itraconazole for 12 months: this is an antifungal used for conditions like chromoblastomycosis or sporotrichosis; leprosy is bacterial, not fungal, so azoles are ineffective. A. Flucloxacillin for 7 days: this targets staphylococci and streptococci in skin and soft tissue infections; it has no action against mycobacteria and the short course would not address a chronic granulomatous nerve disease. D. Single-dose azithromycin alone: azithromycin monotherapy is used for conditions like uncomplicated chlamydia or as part of yaws treatment, but single-dose or single-agent therapy risks rapid resistance in M. leprae and is not WHO-recommended for leprosy of any classification. Key point: A positive slit-skin smear defines multibacillary leprosy, mandating 12 months of triple therapy (rifampicin, dapsone, clofazimine) rather than the shorter paucibacillary regimen.
Reference: World Health Organization, Guidelines for the diagnosis, treatment and prevention of leprosy (2018): multidrug therapy with rifampicin, dapsone and clofazimine for 12 months is recommended for multibacillary leprosy. https://www.who.int/publications/i/item/9789290226383