Current tuberculosis and non-tuberculous mycobacterial disease guidelines recommend the use of clofazimine in a 100 mg once-daily dose. The rationale behind this exact dose is not provided. I performed a literature review to determine the reasoning behind the current dosing regimen. The current 100 mg once-daily dose of clofazimine stems from a deliberate attempt to find the minimum effective daily dose in leprosy treatment, driven by efficacy, economical and toxicity considerations. While this dose is safe, economical and practical, a higher dose with a loading phase may add relevant efficacy and treatment-shortening potential to both tuberculosis and non-tuberculous mycobacterial disease treatment. We need to revisit dose–response and maximum tolerated dose studies to get the best out of this drug, while continuing efforts to generate more active r-iminophenazine molecules that accumulate less in skin and intestinal tissues and have pharmacokinetic properties that do not require loading doses.

中文翻译：

---

为什么我们在结核病和 NTM 治疗中使用 100 毫克氯法齐明？

目前的结核病和非结核分枝杆菌疾病指南建议使用氯法齐明，剂量为 100 毫克，每日一次。没有提供这个确切剂量背后的基本原理。我进行了文献综述，以确定当前给药方案背后的原因。当前的氯法齐明每日一次剂量为 100 毫克，源于出于功效、经济和毒性考虑而有意寻找麻风病治疗中的最低有效日剂量。虽然该剂量安全、经济且实用，但负荷阶段的更高剂量可能会增加结核病和非结核分枝杆菌疾病治疗的相关疗效和缩短治疗的潜力。我们需要重新审视剂量反应和最大耐受剂量研究，以充分利用这种药物，同时继续努力产生活性更高的 r-亚氨基吩嗪分子，这些分子在皮肤和肠道组织中积累较少，并且具有不需要负荷剂量的药代动力学特性。