Are Guidelines for Field Treatment of Leprosy Reactions Evidence-Based? A Comprehensive Literature Review

Abstract

Purpose: Much of the stigma associated with leprosy is caused by disfiguring disabilities following irreversible nerve damage and much of this damage is the end result of leprosy reactions which are either not recognized in early enough stages, not treated appropriately or both. In an effort to improve access to care, to reduce stigma and to integrate leprosy into general health care services, guidelines for standardized treatment in field conditions of the infection itself and of leprosy reactions have been developed and implemented. This has sparked debate among experts concerning the efficacy of treatment protocols for especially leprosy reactions outlined in the guidelines. The principle points of contention are the duration of treatment, dosage and tapering strategies of the drug mainly used, prednisolone. This study investigates on what evidence these guidelines are based. Methods: Electronic databases were used in search of randomized controlled trials and other non-randomized evidence that could shed light on the validity of the strategies advocated and already implemented in most leprosy control programs