Implementation of WHO MDT in Brazil

The recommendation of the WHO Study Group to introduce MDT for the treatment of leprosy met with considerable resistance in Brazil. The National Department for Dermatological Disease (DNDS) advanced a number of arguments against the adoption of WHO MDT by Brazil (1) including: • significant risk of side-effects; • efficacy not proven; • lack of evidence to confirm: – speedier attainment of smear-negative results, – reduction of disease incidence, not achieved by dapsone monotherapy – reduced resistance to dapsone, – reduction of relapse caused by bacterial persistence; • stigmatizing changes in skin pigmentation caused by clofazimine; • costs and availability.