Since 1979 all leprosy patients in the main treatment centres in The Netherlands have been treated with a multiple drug regimen. Pre-treated nonlepromatous patients received 600 mg rifampicin and 100 mg dapsone daily for 6 months. In previously untreated patients dapsone treatment was continued for Ii years more. For several reasons the combination of rifampicin and Isoprodian was not used: Isoprodian is not registered in The Netherlands and to obtain registration would have been time consuming

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... and difficult. Previous experiences with prothionamide in drug combinations were not encouraging. Out of 15 patients, 3 developed hepatitis, in 2 cases a severe hepatitis. It was thought to be interesting to test another drug combination in a situation where the chance of reinfection is remote. A combination without prothionamide and isoniazid would be interesting for comparison with the Malta regimen and a regimen including daily rifampicin would be interesting for comparison with the WHO Study Group regimen. About 400 patients, nearly one-third being lepromatous or borderline lepromatous, have completed the course of multiple drug therapy and have been fo llowed up clinically and serologically for 3-6 years. Most lepromatous patients have been without treatment for 3-5 years, most nonlepromatous patients for 4--6 years. Until one month ago no relapses were seen. Then a lepromatous patient who had completed MDT, reported with a single, small nodule on his wrist. The serological test with monoclonal antibodies against My cobacterium leprae specific phenolic glycolipids showed levels which were as high as seen in active lepromatous leprosy. Relapse was confirmed by a biopsy, showing BI 5 +, with 27% nongranular bacilli. The patient had been treated with dapsone since 1957 and a first relapse occurred in 1972. Combined treatment was started in February 1980 and treatment was withdrawn in February 1981. In 1980 no bacilli were fo und in a biopsy specimen. The second relapse occurred 5 years after cessation of treatment. 272 0305-75 I 8j86j057272S +02 $0 1 .00