[Adhesion to leprosy treatment: inherent difficulties of the patients]

The interference of polypharmacy and the importance of clinical pharmacy advice in the treatment of leprosy: a case-control study

INTRODUCTION:

Although supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy.

METHODS

We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multivariate analysis by logistic regression was used for calculating odds ratio (OR).

RESULTS:

This study included 103 patients, of whom 43 needed to discontinue leprosy treatment (hemolysis = 26, hepatitis = 2, hemolysis associated with hepatitis = 6, and suspected treatment resistance = 9) and the rest did not. The severity of drug interactions had no effect on treatment discontinuation. Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79-9.12; p < 0.001). The number of drugs used also positively influenced the occurrence of hemolysis (p < 0.001). No patient presented evidence of molecular resistance to rifampicin, dapsone, or ofloxacin treatment, as evidenced by genetic sequencing detection of rpoB, folp1, and gyrA mutations.

CONCLUSIONS:

Polypharmacy has deleterious effects on the already difficult-to-adhere-to treatment of leprosy and polypharmacy induces hemolysis. Additional measures must be taken to avoid the undesirable effects of inadequate polypharmacy.

[Marks on oneself: experiencing the pain of (self) preconception]

Qualitative research whose objective was to understand the social representations of the body by women with alterations caused by leprosy, for nursing care can meet more broadly to your needs. The theoretical framework was the social representations. Forty-three women participated, all of them from a reference unit specialized in sanitary dermatology. Interviews were conducted, which contents were processed by the software ALCESTE, generating a class whose words were associated with preconception anchored in the negative perception of leprosy. The explanatory framework of social representations showed a strong brand of the social memory of leprosy, whose symbolic construction sustains itself on fear of the disease. It was concluded on the need to invest in the deconstruction of archaic beliefs about leprosy so that to have new ways of acting towards the disease.

Leprosy treatment dropout: a systematic review

Background

Leprosy is a chronic infectious disease endemic in some undeveloped areas, and still represents a public health problem in Brazil. Therefore, the control of this endemic disease depends necessarily on the institution of correct treatment and containment of treatment dropout. This study aims to conduct a systematic review of published studies on treatment dropout of leprosy.

Methods

We conducted a systematic review of articles on treatment dropout of leprosy, published between january 2005 and april 2013, on MEDLINE and SciELO databases. The search was performed using the MeSH terms: “leprosy”; “patients dropouts” and the keywords: “leprosy, treatment” and “noncompliance, leprosy” in association, beside the equivalents in Portuguese.

Results

There were originally 196 references. After analyzing the titles and abstracts of articles, 20 articles were obtained and included in the final sample.

Discussion

Leprosy is a notifiable disease known as its disfiguring capability and the high rate of non-compliance to treatment. The low adhesion is responsible for the remaining potential sources of infection, irreversible complications, incomplete cure and, additionally, may lead to resistance to multiple drugs. Many factors are responsible for the interruption or dropout treatment: socioeconomic factors, education level, knowledge about the disease, lack of efficiency of health services, demographics, side effects of drugs, alcoholism, among others.

Conclusion

The recent scientific literature about the subject diverge regarding the factors that most affect the dropout problem in treating leprosy patients. However, better integration between professionals and users, and greater commitment of the patient, are common points among the authors of the studies.