Before any treatment with prednisolone is given the following concurrent diseases should be treated as well;

• diarrhoea with blood and/or mucus. If this is present the patient may suffer from bacillary or amoebic dysentery

• conjunctivitis and trachoma

• scabies

• worm infestations.

Treatment for these conditions is started immediately, but need not to be finalized before starting with prednisolone.

If complications of prednisolone occur, the most common are;

• exacerbation of tuberculosis, of which no symptoms were present at the time of starting prednisolone. If tuberculosis is suspected, the patient should be referred to hospital immediately

• signs of diabetes: thirst, excessive urinating, fatigue. Check the urine for glucose and, if positive, refer the patient to hospital immediately

• general illness and/or fever; refer the patient to hospital immediately

• abdominal discomfort: treat the patient with antacids.

Criteria for referral to hospital of patients with reversal reaction (RR)

All patients with a severe reversal reaction should be treated in the field, with the exception of the following categories of patients;

• patients with deep ulcers
• patients with a nerve abscess
• patients with corneal ulcer or keratitis
• patients who are pregnant
• patients suspected of tuberculosis or any other serious infectious disease
• patients with a positive urine test for glucose or protein
• patients who develop nerve damage 2 years or more after release from MDF
• patients under the age of 12 years
• patients with a recent history of peptic ulcer
• patients who have a history of diabetes.