Combination of rifapentine-moxifloxacin-minocycline (PMM) for the treatment of leprosy

To further the development of a multidrug regimen for treatment of leprosy that is suitable for monthly administration and fully supervisable, the bac tericidal activities against Mycobacterium leprae of HMR 3647 (HMR), moxifl oxacin (MXFX) and rifapentine (RPT) were measured by the proportional bacte ricide technique in the mouse footpad system, and compared with those of th e established antileprosy drugs clarithromycin (CLARI), ofloxacin (OFLO) an d rifampicin (RMP). Administered in five daily doses of 100 mg per kg body weight, HMR appeared slightly more bactericidal than CLARI, but the differe nce did not attain statistical significance. Administered as single doses, MXFX in a dosage of 150 mg per kg was more active than OFLO in the same dos age, and displayed the same level of activity as RMP in a dosage of 10 mg p er kg; the combination MXFX-minocycline (MINO) (MM) was more bactericidal t han the combination OFLO-MINO (OM); RPT in a dosage of 10 mg per kg was mor e bactericidal than RMP administered in the same dosage, and even more acti ve than the combination RMP-OFLO-MINO (ROM); the combination RPT-MXFX-MINO (PMM) killed 99(.)9% of viable M. leprae, and was slightly more bactericida l than was RPT alone, indicating that the combination PMM showed an additiv e effect against M. leprae. These promising results justify a clinical tria l among lepromatous patients, in which MM is being compared with OM, and PM M with ROM, in terms of efficacy and tolerance.