02867nas a2200505   4500000000100000008004100001260001300042653001500055653001000070653000900080653001200089653001000101653001900111653003100130653003000161653001100191653001100202653002300213653001200236653000900248653000900257653003200266653001600298653002500314653001600339653001500355653001700370653003000387100001500417700001500432700001100447700001300458700001300471700001300484700001500497700001300512700001300525245010600538856004100644300001100685490000700696050001700703520162700720022001402347       2003                            d  c2003 Dec10aAdolescent10aAdult10aAged10aAnimals10aChild10aCohort Studies10aDrug Resistance, Bacterial10aDrug Therapy, Combination10aFemale10aHumans10aLeprostatic Agents10aleprosy10aMale10aMice10aMicrobial Sensitivity Tests10aMiddle Aged10aMycobacterium leprae10aPhilippines10aRecurrence10aTime Factors10aWorld Health Organization1 aCellona RV1 aBalagon MV1 aCruz E1 aBurgos J1 aAbalos R1 aWalsh GP1 aTopolski R1 aGelber R1 aWalsh DS00aLong-term efficacy of 2 year WHO multiple drug therapy (MDT) in multibacillary (MB) leprosy patients.  uhttp://ila.ilsl.br/pdfs/v71n4a01.pdf  a308-190 v71  aCELLONA 20033 a<p>Relapse rate estimates after 2 year WHO multiple drug therapy (MDT) in multi-bacillary (MB) leprosy vary. Between 1987 and 1994, 500 MB leprosy patients completing 2 year MDT were enrolled in a prospective relapse study. The majority of patients (N = 316) were treated and followed at the physician-staffed Cebu Skin Clinic (CSC), whereas others (N = 184) received therapy from government clinics and were followed by CSC technicians in the field. Relapse definition was an increased bacteriologic index (BI) and new skin lesions, supplemented with mouse footpad inoculations. Through 2002, follow-up was 5368 person-years, with a mean of 10.8 years per patient. The absolute relapse rate was 3% (15/498; 0.28/100 person-years), with a cumulative risk estimate of 3.9% at 15 yrs. For a subset of 217 patients followed for >or=12 yrs or until relapse, relapses occurred in 9% (13/142) attending the CSC, versus 3% (2/75) assessed in the field (p = 0.09). The rate for patients followed at CSC for >or=12 yrs and a pre-treatment BI >or=2.7+ was 13% (13/98). All relapses were BL or LL, with pre-treatment BI's of >or=2.7+. Relapses occurred long after completion of therapy, between 3 and 11 yrs from the midpoint of the examination without relapse to detection, or between 6 to 13 yrs to the actual year of detection, 7 occurring at >or=10 yrs. Lesion material from all relapses contained M. leprae that was rifampin and clofazimine sensitive, whereas 3 showed partial or full dapsone resistance. [Follow-up rigor and time], medical expertise, and pre-treatment bacterial load influence relapse rates after 2 yr MDT.</p>  a0148-916X