Mycobacterium ulcerans treatment--can antibiotic duration be reduced in selected patients?

Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessatio...

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Bibliographic Details
Published in:PLoS neglected tropical diseases 2015-02, Vol.9 (2), p.e0003503
Main Authors: Cowan, Raquel, Athan, Eugene, Friedman, N Deborah, Hughes, Andrew J, McDonald, Anthony, Callan, Peter, Fyfe, Janet, O'Brien, Daniel P
Format: Article
Language:English
Subjects:
Adjuvants, Immunologic - therapeutic use
Adult
Aged
Antibiotics
Antibiotics, Antitubercular - therapeutic use
Australia
Buruli Ulcer - drug therapy
Buruli Ulcer - microbiology
Buruli Ulcer - surgery
Ciprofloxacin - therapeutic use
Clarithromycin - therapeutic use
Dosage and administration
Drug therapy
Drug Therapy, Combination
Female
Humans
Infections
Male
Medical treatment
Middle Aged
Mycobacteria
Mycobacterium
Mycobacterium ulcerans
Mycobacterium ulcerans - drug effects
Patient outcomes
Retrospective Studies
Rifampin - therapeutic use
Risk Factors
Success
Surgery
Toxicity
Treatment Outcome
Tuberculosis
Ulcers
Withholding Treatment
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Summary:Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessation and local experience suggests that shorter antibiotic courses may be effective with concurrent surgery. We report the outcomes of patients in the Barwon Health M. ulcerans cohort who received shorter courses of antibiotic therapy than 8 weeks. A retrospective analysis was performed of all M. ulcerans infections treated at Barwon Health from March 1, 1998 to July 31, 2013. Sixty-two patients, with a median age of 65 years, received < 56 days of antibiotics and 51 (82%) of these patients underwent concurrent surgical excision. Most received a two-drug regimen of rifampicin combined with either ciprofloxacin or clarithromycin for a median 29 days (IQR 21-41 days). Cessation rates were 55% for adverse events and 36% based on clinician decision. The overall success rate was 95% (98% with concurrent surgery; 82% with antibiotics alone) with a 50% success rate for those who received < 14 days of antibiotics increasing to 94% if they received 14-27 days and 100% for 28-55 days (p
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0003503