Penatalaksanaan kusta pada pasien geriatri memerlukan pengawasan ketat. Risiko efek samping pemberian multi drug treatment (MDT-WHO) pada pasien geriatri lebih besar daripada pasien bukan geriatri. Rejimen rifampisin-ofloksasin-minosiklin (ROM) tidak dianjurkan untuk pasien berusia lebih dari 65 tahun. Sebagai alternatif dapat diberikan rejimen rifampisin dan klaritromisin selama 3 bulan. Salah satu kendala pada penyakit lepra adalah reaksi lepra.
        Wanita, 82 tahun, dengan kusta multibasilar tipe borderline lepromatous. Diagnosis ditegakkan berdasarkan anamnesis, gejala klinis dan bakterioskopis. Dengan rejimen rifampisin 600 mg per bulan dan klaritromisin 500 mg per hari selama 3 bulan didapatkan perbaikan klinis, dan bakterioskopis. Dua bulan pasca terapi terjadi reaksi reversal ringan yang diterapi kombinasi kalium diklofenak, krim betametason dipropionat 0.05% yang dilanjutkan krim mometason furoat 0.1%. Setelah 7 bulan didapatkan perbaikan klinis. Efek samping selama terapi hanya mual.
      Rejimen rifampisin-klaritromisin dipilih pada kasus ini karena durasi, jumlah dan frekuensi pemberiannya minimal dibanding rejimen lainnya sehingga risiko efek samping minimal. Reaksi tipe I ringan umumnya diatasi dengan golongan anti inflamasi non steroid (AINS). Diklofenak merupakan obat yang paling baik ditoleransi dibandingkan bahan AINS lainnya. Kalium diklofenak lebih cepat bereaksi dibandingkan natrium diklofenak.(MDVI 2011; 38/s: 55s - 63s)

Kata kunci: geriatri, kusta multibasiler tipe borderline leprosy, reaksi reversal ringan, rejimen
rifampisin-klaritromisin, kalium diklofenak

       Leprosy management on geriatric patient needs strict supervision. The side effect risk on prescribing Multi Drug Treatment (MDT-WHO) on geriatric patient is bigger than the non-geriatric. Rifampicin-ofloxacin-minocycline regimen (ROM) is not recommended for patient with age more than 65 years old. As alternative rifampicin and clarithromycin for 3 months can be given. One of the constraints on leprosy is the leprosy reaction.
        Female, 82 years old, with borderline lepromatous leprosy. The diagnosis was based on history, clinical, and bacterioscopic. Two months post rifampicin-clarithromycin regimen treatment a slight reversal reaction appeared which treated by the combination of potassium diclofenac, betamethasone dipropionate 0.05% cream and continued with momethasone furoate 0.1% cream. After 7 months the clinical improvement was occupied. The only side effects found during treatment was nausea.
       Rifampicin-clarithromycin regimen was chosen on this case because of its duration, quantity, and frequency were minimal compared to other regimens. The mild type 1 reaction was treated with a group of nonsteroidal anti-inflammatory medications (NSAIDs). Diclofenac is among the better tolerated NSAIDs. Potassium diclofenac has a faster reaction than natrium diclofenac .(MDVI 2011; 38/s: 55s - 63s)

Key words: borderline lepromatous leprosy; mild reversal reaction, geriatric, rifampicinclarithromycin
regimen, diclofenac potassium