Drug choice to lowering risk contiguity with Morbus Hansen

disease: A review article

Nanda Rachmad Putra Gofur1*, Aisyah Rachmadani Putri Gofur2, Hernalia Martadila Putri3,
Soesilaningtyas4, Annisa Nur Halimah1, Dwiyanti Feriana1, Elly Rusdiana1, Sri Wahjuni1, Mia Laksmi
Lita Rosa1, Zamros Yuzadi Bin Mohd Yusof5
1
Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Indonesia. 2Graduate Student of Dental Health Science, Faculty of Dental Medicine, Universitas
Airlangga, Indonesia. 3Narizma Healthcare, Surabaya, Indonesia. 4Deptartment of Dental Nursing, Politeknik Kesehatan, Indonesia.5Department of Community Oral Health
and Clinical Prevention, Faculty of Dentistry, Universiti Malaya (UM), Kuala Lumpur, Malaysia.

Correspondence: Nanda Rachmad Putra Gofur, Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Indonesia.
nanda.rachmad.gofur@vokasi.unair.ac.id
ABSTRACT
Morbus Hansen is a chronic infectious disease caused by the bacteria Mycobacterium lepromatosis and Mycobacterium leprae.
Mycobacterium lepromatosis was found as a Morbus Hansen pathogen in an endemic case that occurred in South America in the 20th
century. In comparison with females, Morbus Hansen cases are more common in males. An increase in the incidence of Morbus Hansen
occurs in people with household contacts with Morbus Hansen sufferers. The incidence rate is higher in contacts with multibacillary
cases (MB) than in paucibacillary (PB) 5-14 times. Many studies have revealed that chemoprophylaxis administration or in combination
with immunoprophylaxis in individuals who have come in contact with the Morbus Hansen patient is quite effective in the reduction of
the detection rate of new Morbus Hansen cases in endemic areas. Various options of drugs can be utilized as prophylaxis in lowering risk
contiguity with Morbus Hansen. Unfortunately, the effectiveness is low, because strains of M. leprae were resistant to various drug
types. This article aims to review drug choice for high-risk contiguity with Morbus Hansen. Drug choice prophylaxis against Morbus
Hansen is mainly given to those who had contacts with Morbus Hansen patients. Prophylaxis as dapsone, clofazimine, and rifampin is
effective in lowering the risk of the incidence of Morbus Hansen disease in individuals had contiguity with Morbus Hansen patients.
Furthermore, research needs to confirm drug prophylaxis for lowering risk who had contact with Morbus Hansen.

Keywords: Drug prophylaxis, Health risk, Morbus hansen disease, Illness

Hansen cases are more common in males. An increase in the

Introduction incidence of Morbus Hansen occurs when people of the
household come in contact with Morbus Hansen sufferers. The
Morbus Hansen is a chronic infectious disease caused by the
incidence rate is higher in contacts with multibacillary cases (MB)
bacteria Mycobacterium lepromatosis and Mycobacterium
than in paucibacillary (PB) 5-14 times [1].
leprae. Mycobacterium lepromatosis was found as a Morbus
Morbus Hansen disease can occur at any age and children are
Hansen pathogen in an endemic case that occurred in South
more susceptible to contracting Mycobacterium leprae infection
America in the 20th century. In comparison with females, Morbus
than adults. This disease is transmitted from one person to
Access this article online another through airborne droplets. The Mycobacterium leprae
spread can also be influenced by several factors, including
Website: www.japer.in E-ISSN: 2249-3379
socioeconomic status, population density, nutrition, and
immune response. The endemicity rate in a region also describes
the degree of public health facilities and the BCG immunization
How to cite this article: Gofur NRP, Gofur ARP, Putri HM, Soesilaningtyas, attainment rate in a region [2].
Halimah AN, Feriana D, et al. Drug choice to lowering risk contiguity with
Morbus Hansen disease: A review article. J Adv Pharm Educ Res. Early detection of Morbus Hansen disease in individuals who
2023;13(1):73-9. https://doi.org/10.51847/CksXmT6VSy have contact with Morbus Hansen patients and
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ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is
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© 2023 Journal of Advanced Pharmacy Education & Research | Published by SPER Publication 73
 Gofur et al.: Drug choice to lowering risk contiguity with Morbus Hansen disease: A review article

chemoprophylaxis is the main strategy in breaking the chain of Some patients have hemolytic conditions, especially those with
the spread of Morbus Hansen's disease [3]. Various studies have G6PD deficiency. Gastrointestinal symptoms such as nausea and
shown that administration of chemoprophylaxis or in vomiting may occur. Fever, insomnia, headache, photosensitivity
combination with immunoprophylaxis in individuals who have may also occur. Blood disorders in the form of anemia,
contact with the Morbus Hansen patient is quite effective in leukopenia, and agranulocytosis were also found in some patients
reducing the detection rate of new Morbus Hansen cases in on dapsone therapy. Skin disorders such as exfoliative dermatitis,
endemic areas. Various drug options can be used as prophylaxis pruritus, toxic epidermal necrolysis (TEN), and several other
in lowering risk contiguity with Morbus Hansen [4]. dermatological reactions can occur. In some cases, erythema
Unfortunately, the effectiveness is low, because strains of M. nodosum was also found, although it is sometimes difficult to
leprae were resistant to various types of drugs. This article aims distinguish between reactions due to dapsone and conditions
to review drug choice for high-risk contiguity with Morbus caused by Morbus Hansen himself. Erythema Nodosum
Hansen. Leprosum can be treated with corticosteroids or thalidomide [7,
8].
Results and Discussion
Rifampin
Rifampin can be easily absorbed in oral administration, but food
Dapsone can slow down or reduce the peak plasma reach, so oral
Dapsone is a sulfonamide class of antibiotics. Dapsone can be administration should be done on an empty stomach. Rifampin
easily absorbed in the intestine and is widely distributed through has a peak plasma time 2-4 hours after consumption. The half-
body fluids and most body tissues with a peak plasma time of 4-8 life for rifampin is about 3 to 4 hours, which is prolonged in
hours after consumption. The half-life for dapsone is about 1 to conditions of liver damage, and in patients with chronic renal
2 days, and dapsone tends to be deposited in the skin, muscles, failure, the half-life can be up to 11 hours [9].
liver, and kidneys. The mechanism of action of dapsone is to Rifampin is a highly lipophilic drug, can easily cross the blood-
inhibit the action of para-aminobenzoic acid (PABA) from brain barrier, and can provide relative diffusion from blood to
bacteria used for folic acid synthesis by acting as a competitive cerebrospinal fluid with or without inflammation. The
inhibitor of PABA. Dapsone has a bactericid and bacteriostatic mechanism of action of rifampin is to inhibit DNA-dependent
effect on Mycobacterium leprae [5]. RNA polymerization by binding to the beta subunit thereby
Dapsone is metabolized in the liver by CYP 3A4 as well as in the stopping RNA transcription. Rifampin also has the potent ability
kidneys. This drug is then excreted into the bile and reabsorbed to induce enzyme action (CYP 3A4). Rifampin has a strong
in the intestine. Dapsone is then excreted in the urine as bactericidal effect against Mycobacterium leprae [10].
metabolites (85%), and most of it is in acetylated form. Dapsone Rifampin is metabolized in the liver and then undergoes
was the first sulfonamide class of drugs to be administered orally. enterohepatic recirculation. This drug is then excreted through
Since 1940, dapsone has been the drug of choice for leprosy feces (60-65%) and urine (30%) in the form of a fixed
therapy, until the standard therapy for leprosy changed in the compound. The usual dose of rifampin in adults with Morbus
1980s to multi-drug therapy with the dapsone-rifampin- Hansen is 10 mg/kg/day with a maximum daily dose of 600 mg.
clofazimine combination. Based on a meta-analysis conducted by While the dosage for children depends on their body weight with
the MILEP study group, dapsone also has chemoprophylactic a dose of 10-20 mg / kgBW / day with a maximum daily dose of
properties with efficacy of around 60%. The disadvantages of 600 mg. Rifampin bonds with protein by 80%, so in patients with
dapsone as chemoprophylaxis are increased resistance to dapsone hypoalbuminemia, the rifampin dose needs to be adjusted [11].
and poor patient adherence due to long-term therapy [6]. Rifampin is contraindicated in patients who have hypersensitivity
The usual dose of dapsone in adults with Morbus Hansen is 100 to rifampin, in patients who are being given live vaccines, and
mg per day. While the dose for children depends on their body also in patients who are taking drugs such as tenofovir, ritonavir,
weight with a dose of 1-2 mg / kgBW. In patients with liver and and saquinavir because they increase the risk of developing severe
kidney disorders, the dapsone dose should be adjusted. Dapsone hepatocellular toxicity, and are taken with some antiviral drugs.
is contraindicated in patients who are hypersensitive to the drug other because rifampin can substantially reduce plasma
or this drug class [5]. concentrations of these antiviral drugs, thereby reducing the
Resistance to dapsone increased with the use of dapsone as a efficacy of treatment and can lead to the emergence of resistance
single therapy in the case of Morbus Hansen. This then became to these antivirals [12].
the basis for consideration of Morbus Hansen's standard change Rifampin can also decrease the effectiveness of oral
of therapy in the 1980s from single dapsone therapy to multidrug contraceptives because it increases the metabolism of these
therapy consisting of dapsone, rifampin, and clofazimine. By drugs. In patients on anticoagulant therapy, rifampicin
administering MDT, it is hoped that the resistance rate of administration can also decrease the effectiveness of this therapy
Mycobacterium leprae to existing therapy regimens, including by inducing hepatic enzymes so that anticoagulant metabolism
dapsone, can be reduced [6]. occurs more quickly. The administration of rifampin to patients
with a history of diabetes mellitus also needs to be watched out,

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 Gofur et al.: Drug choice to lowering risk contiguity with Morbus Hansen disease: A review article

for because rifampin makes the management of diabetes mellitus Accumulation of this drug in macrophages can benefit patients
more difficult [13]. and inhibit intracellular multiplication of Mycobacterium leprae
Resistance to rifampin can occur when a spontaneous mutation [18].
in bacteria makes the bacterial RNA polymerase enzyme lose This drug accumulates in large amounts in the skin, subcutaneous
affinity for the antibiotic. In addition, resistance to rifampin can fat, liver, lungs, adrenals, kidneys, lymph nodes, and
be influenced by the presence of an enzyme that deactivates gastrointestinal tract. The accumulation of this drug in the tissues
rifampin by transferring the ADP-ribosil molecule to one of the results in staining of the organs and skin. This drug is excreted
hydroxyl groups on the aliphatic carbon chain in the antibiotic very slowly from the body, usually taking an average of 6-12
rifampin. Resistance via enzymes can be spread by horizontal months. Thus, it will take a long time for the patient to achieve
spread via plasmids [14]. normal skin color. Small amounts of the drug component can still
Rifampin generally causes an orange discoloration of urine and be found even after 3 years after stopping the clofazimine
other body fluids such as sweat and tears, but this condition is treatment. Accumulation of clofazimine in macrophages likely
temporary and will resolve completely with the discontinuation affects the capacity of macrophages to process and present
of drug administration. Some patients have increased hepatic antigens thereby limiting their movement and activation, IL-2
function (increased AST / ALT) because rifampin is hepatotoxic. release, and clonal expansion. In contrast to dapsone, this drug
Some patients also present with skin rashes, epigastric pain, has a role in suppressing the release of cytokines (IL-1) causing
anorexia, nausea, vomiting, diarrhea, abdominal cramps, decreased movement of lymphocytes to the type 1 reaction site
jaundice, and hepatitis. In addition, the administration of or reversal reaction [19].
rifampin above the maximum daily dose can cause the flu-like Due to the long half-life of this drug (about 2 months) and its
syndrome, which is characterized by fever, chills, and myalgia, tissue storage, it can maintain activity even when given
disruption of hematopoiesis resulting in anemia, leukemia, or intermittently, although intermittent administration is not as
thrombocytopenia. Rifampin therapy should be discontinued if effective as regular daily administration or when given
the patient shows signs of liver damage, including intermittently every 2 days. Clofazimine is equally able to play
hyperbilirubinemia [15]. an active role against Mycobacterium leprae which is sensitive to
dapsone and against Mycobacterium leprae which is resistant to
dapsone [20].
Chlofazimine
The clinical response produced by administering a daily dose of
This iminophenazine synthetic dye has been used as a therapeutic
clofazimine 50-100 mg is almost the same as that produced by
agent for leprosy for more than 3 decades. In 1962, Brown and
administering 100 mg of dapsone, although the effect exerted by
Hogerzeil demonstrated clinical and bacteriological
this drug is slightly slower. Nearly all types of leprosy respond
improvement in lepromatous patients using this therapy. This
well to this drug. However, it should not be given as a single drug
was immediately confirmed by a study conducted by the National
or as a cheaper and more effective substitute for dapsone. This
Institute of Health (NIH), Bethesda, USA. This drug has mild
drug is indicated for patients with type 2 reactions even though
bactericidal properties against the bacteria Mycobacterium
the anti-inflammatory action it produces is very slow. This drug
leprae, with a slightly weaker effect than dapsone. Although it is
has a special role in the prevention and management of patients
not certain how this drug works, it is possible that this drug
with chronic ENL reactions. Several investigators have shown
works by inhibiting the function of DNA prints. Numerous
that clofazimine can reduce the risk of hypersensitivity-type
studies have shown that the accumulation of clofazimine in
reactions [21].
macrophages, the site of Mycobacterium leprae, causes the local
Resistance to clofazimine is rare. However, when given as a
emergence of superoxide and hydroxyl radicals. These products
single drug, Mycobacterium leprae tends to become resistant to
are inhibitors of the multiplication of Mycobacterium leprae [16].
this drug. Thus, like other antileprosies, clofazimine should be
This drug acts as an anti-inflammatory which may benefit type 2
given only as part of MDT and not given as a single drug.
reactions. Simulation of PGE2 synthesis and inhibition of
Reddish-brown staining of the skin, due to deposition of
neutrophil motility, together with selective suppression of Th-1
clofazimine in the skin, is quite common. This discoloration is
subtype T-helper cells, is thought to also increase the role of this
more pronounced in sun-exposed areas of the skin including the
drug in type 2 reactions. This drug is not water-soluble so the
face and this is a factor in the disfavor of this drug among white
micronized crystal components included in gelatin capsules need
individuals/races. Xerosis of the skin can be found and at a later
to be dissolved in an oil-based vehicle and encapsulated into soft
stage ichthyosis acquired with a brownish color in the extensor
gelatin for oral consumption. Although it has been formulated in
area and localized in the area of the lesion (due to the ceroid-like
this form, the percentage of absorption of this drug in the
pigment) is common. In some patients, hyper melanosis can be
intestine is 30-50%. Giving a dose of 50 mg will produce a serum
found [22].
level of 0.5 μg while giving a dose of 300 mg only increases
Other side effects are frequently seen in patients with reactions,
serum concentration levels 2 times that of the 50 mg dose [17].
who receive a daily dose of 200-300 mg per day for a long period
In humans, as in mice, the drug enters several organs and is stored
and an effect that results from the deposition of clofazimine in
in them in the form of needle-like crystals, mainly deposited in
reticuloendothelial cells in several organs. In women, this can
macrophages and cells of the reticuloendothelial system.
lead to abdominal problems, such as pain or diarrhea, which in
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 Gofur et al.: Drug choice to lowering risk contiguity with Morbus Hansen disease: A review article

turn can lead to malabsorption and cachexia. In severe cases, compared with control (placebo) in protecting individuals who
hypokalemia and death may occur. Decreased volume of sweat had contact with MH lepromatous type patients. Meanwhile,
and tears, possibly as a result of the anticholinergic action, dapsone with the general dose only gave a significant difference
including dryness of the skin and eyes, makes it more difficult for compared to controls in protecting individuals in contact with
patients with leprosy. This can severely affect patients with non-lepromatous MH-type patients. Several clinical
corneal xerosis and lagophthalmos. The episclera may also investigations noted that in general the duration of dapsone as
experience discoloration. Findings of splenic infarction and monotherapy for MH lepromatous in 5 years often results in a
ceroid congestion in the small intestine have also been reported, relapse of the disease after discontinuation of therapy.
in addition to findings of reddish sputum due to excretion of Consequently, life-long sulfone therapy in MH lepromatous is
clofazimine crystals in the respiratory tract - mimicking recommended [25].
hemoptysis. It can also cross the placental barrier and affect fetal The results of the meta-analysis regarding the use of dapsone as
skin. Until now, it is still unknown the possible teratogenic chemoprophylaxis show that giving dapsone for a long time
effects that could result [23]. provides effectiveness of 60%. The effectiveness of dapsone
chemoprophylaxis in contact individuals who live at home with
Morbus Hansen patients varies between 34% and 54%.
Research about chemoprohpylaxis drugs
Meanwhile, the mass effect of dapsone chemoprophylaxis in the
population was 91%. The drawbacks of giving dapsone as
Dapson chemoprophylaxis are the problem of drug resistance that often
There are several studies evaluating the effectiveness of dapsone arises and the low level of adherence are low due to the long
as chemoprophylaxis at a weekly or bi-weekly dose for two years. period of time [25].
A study on 732 healthy children under 15 years of age with Research evaluated the relative risk of developing secondary
contact Morbus Hansen at home in Table 1. The study was dapsone resistance in several countries and found across the
conducted by giving dapsone 20-150 mg twice a week for the surveyed regions that dapsone resistance was very frequent and
first 6 months and 10-75 mg as a maintenance dose until the end mostly high-level resistance (0.01% in experimental mice
of the study period. Wardekar observed the effectiveness of equivalent to 100 mg in humans). In Ethiopia, Pearson reported
dapsone as chemoprophylaxis in 27 villages compared to 27 other that as many as 15% of patients with MH lepromatous experience
villages as controls. Dapsone appears to provide significant a dapsone resistance relapse. When tested on these Ethiopian
protection against Mycobacterium leprae infection by preventing strains on mice, unlike in other regions, the majority had
the emergence of new cases of Morbus Hansen in the general resistance to 0.0001% dapsone in mice and not to a higher degree
population, especially in patients under the age of 25 years [24]. [16]. In conclusion, the findings of the prevalence of relapses of
Another study conducted by Noorden and Neelan showed secondary dapsone resistance were not high. However, it only
different results. Dapsone with common doses (75 mg) and low occurs in special circumstances in the most ideal setting such as
doses (50 mg) did not provide a significant difference when in Malaysia and does not occur in all patients [26].

Table 1. Randomized Controlled Trial Dapson as Chemoprophylaxis of Morbus Hansen [19]

Country Author Duration of Disease rate in treated group Disease rate in control group Rate of
No. Year Treated Controls NNT
reference trial in years per 1000 population per 1000 population effiacy

1 1969 India, Wardekar 4.5 12754 12931 0.24 2.78 99% 393
2 1976 India, Noorden 3.5 1000 1000 109.00 0.24 34% 27

of inadequate therapy in the case of sulfone-resistant Morbus

Acedapson Hansen [27].
In 1967-1970, acedapsone was used intramuscularly as an effort
There were two studies conducted by Neelan, namely in 1983
to eliminate Morbus Hansen in the community as a
and 1986 which evaluated the effectiveness of using acedapsone
chemoprophylaxis program in Micronesia. The research was
as chemoprophylaxis against MH type MB. The dose of
conducted by Russel in the endemic area of Morbus Hansen in
acedapsone used is 150-225 mg every 10 weeks for 7 months.
Micronesia where the Morbus Hansen rate reached 41/1000
These two studies showed that acedapsone significantly
population. Study subjects were given 225 mg of acedapsone
prevented the emergence of new cases of Morbus Hansen within
every 75 days for 3 years and reported that the incidence of new
3.5 years and 4.7 years. Noordeen in 1977 also conducted a
cases decreased in the first year, and no new cases were found in
similar study on 700 respondents with 350 respondents given
the second and third years, it showed in Table 2. However, 5
intramuscular acedapson with the same dose. divided into 3 times
years later, the number of new Morbus Hansen cases increased
giving every 10 weeks [28].
again. The failure of chemoprophylaxis is thought to be the result

76 Journal of Advanced Pharmacy Education & Research | Jan-Mar 2023 | Vol 13 | Issue 1
 Gofur et al.: Drug choice to lowering risk contiguity with Morbus Hansen disease: A review article

Table 2. Randomized Controlled Trial Acedapson as Chemoprophylaxis for Morbus Hansen [19]
Country Author Duration of Disease rate in treated group Disease rate in control Rate of
No. Year Treated Controls NNT
reference trial in years per 1000 population group per 1000 population effiacy
1 1977 India, Noorden 2 350 350 51.40 91.43 44% 25

2 1986 India, Neelan 4 280 280 46.42 107.14 54% 17

dose of rifampin in the other group, and the study subjects were
Rifampin followed for up to 6 years. The results of the above study indicate
Rifampicin is a strong bactericidal antibiotic against
that the preventive effect of rifampin was only seen in the first
Mycobacterium leprae, which is the cause of Morbus Hansen,
two years of chemoprophylaxis therapy, additional preventive
and a single dose of rifampin can prevent the occurrence of
effects were not obtained after year 4 and year 6. This
Morbus Hansen disease in people who come in contact with
intervention was found to be most effective in the contact group
patients with Morbus Hansen. Single-dose rifampin provides
of female patients, especially in neighbors and social contacts,
fairly good effectiveness as chemoprophylaxis by protecting 60%
where a trend towards an increased risk of Morbus Hansen
for 2 years, based on research results in Bangladesh [28].
transmission was obtained, followed by an increase in the
In a study conducted by COLEP, it was shown that
effectiveness of a single dose of rifampin. In addition, there were
chemoprophylaxis with SDR (single dose rifampicin) was most
also indications of an increase in the effectiveness of single-dose
effective in relatively low-risk contact groups such as the contact
rifampicin in the contact group in patients who were included in
group with paucibacillary patients, contacts with patients who
the cluster of two or more Morbus Hansen patients at the time
did not live at home or who had no blood relations. It is estimated
of the intervention [30].
that the infected contacts in this group were exposed to less,
A study conducted by Cartel in 1988 showed that rifampin haS a
resulting in a lower bacterial load than those who had closer
protective efficacy of 40-50% (Table 3). Based on an analysis
contact with the patient, making therapy with single-dose
of costs, the combined expenditures between Morbus Hansen
rifampicin more successful [29].
treatment with standard MDT (Multidrug Therapy) regimens
The study was conducted on people who had contact with the
and chemoprophylaxis with rifampin were more effective than
newly diagnosed Morbus Hansen patient, where interventions
treatment expenditures. Morbus Hansen with standard MDT
were given in the form of a placebo in one group and a single
alone without prophylaxis [30].

Table 3. Number of New Hansen Morbus Cases (6 Years of Follow Up) in the Contact Group based on Gender and Relationship
with Patients and with Prophylaxis [20]
Distance of new case to original index patients
Not close Close
n N per 100 contact groups (95%) n n per 100 contact groups (95% CI)

Female (166) 41 24.7 (18.2-33.5) 12 7.2 (4.1-12.7)

Placebo prophylaxis Sex index patient (n)
Male (342) 28 8.2 (5.7-11.9) 27 7.9 (5.4-11.5)

Total 69 13.6 (10.7-17.2) 39 7.7 (5.6-10.5)

Female (177) 14 7.9 (4.7-13.4) 9 5.1 (2.6-9.8)
Rifampicin prophylaxis Sex index patient (n)
Male (317) 29 9.1 (6.4-13.2) 25 7.9 (5.3-11.7)
Total 43 13.6 (10.7-17.2) 34 6.9 (4.9-9.6)

Another study by Bakker and friends was carried out on five A study conducted on five hyperendemic Indonesian islands
islands in Indonesia that are endemic to Morbus Hansen. A total Morbus Hansen showed that chemoprophylaxis with rifampin in
of 3.965 individuals were given rifampin prophylaxis (600 mg the entire population was more effective than interventions for
rifampin in adults, 300 mg rifampin in children) twice at 3-month close contact with patients only [31]. This approach could be
intervals and then followed for 6 years. All samples were divided considered in areas where Morbus Hansen is highly endemic with
into three groups, namely the contact group for Morbus Hansen an increased risk of transmission and intervention. this can be
patients, the risk group (blanket group), and anyone (the control done at the hamlet, village, or wider scope.
group). After being followed for three years, the Morbus Hansen
incidence rate in the blanket group was significantly lower than
Conclusion
the control group, but there was no significant difference
between the contact group and the control group). Rifampin
administration in the blanket group was effective in preventing Prophylaxis against Morbus Hansen is mainly given to those who
Hansen's Morbus with the effectiveness of 75% [30]. had contacts with Morbus Hansen patients. Prophylaxis as
dapsone, clofazimine, and rifampin is effective in lowering the
risk of the incidence of Morbus Hansen disease in individuals had
Journal of Advanced Pharmacy Education & Research | Jan-Mar 2023 | Vol 13 | Issue 1 77
 Gofur et al.: Drug choice to lowering risk contiguity with Morbus Hansen disease: A review article

contiguity with Morbus Hansen patients. Furthermore, research 10. Ohanube GAK, Obeta UM. mRNA Vaccine: Determinants
needs to confirm drug prophylaxis for lowering risk who had of Clinical Efficacy, and Optimization of Pharmacological
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Acknowledgments: None 11. Eichelmann K, González SG, Salas-Alanis JC, Ocampo-
Candiani J. Leprosy an update: definition, pathogenesis,
classification, diagnosis, and treatment. Actas
Conflict of interest: None
Dermosifiliogr. 2013;104(7):554-63.
12. De Matos HJ, Blok DJ, de Vlas, Richardus JH. Leprosy new
Financial support: None case detection trends and the future effect of preventive
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