Outcomes for Mycobacterium ulcerans infection with combined surgery and antibiotic therapy: findings from a south‐eastern Australian case series

Abstract

Objective: To describe the effect of antibiotics on outcomes of treatment for Buruli or Bairnsdale ulcer (BU) in patients on the Bellarine Peninsula in south‐eastern Australia. Design: Observational, non‐randomised study with data collected prospectively or through medical record review. Patients and setting: All 40 patients with BU managed by staff of Barwon Health's Geelong Hospital (a public, secondary‐level hospital) between 1 January 1998 and 31 December 2004. Main outcome measures: Epidemiology, clinical presentation, diagnosis, treatment and clinical outcomes. Results: There were 59 treatment episodes; 29 involved surgery alone, 26 surgery plus antibiotics, and four antibiotics alone. Of 55 episodes where surgery was performed, minor surgery was required in 22, and major surgery in 33. Failure rates were 28% for surgery alone, and 19% for surgery plus antibiotics. Adjunctive antibiotic therapy was associated with increased treatment success for lesions with positive histological margins (P < 0.01), and lesions requiring major surgery for treatment of a first episode (P < 0.01). The combination of rifampicin and ciprofloxacin resulted in treatment success in eight of eight episodes, and no patients ceased therapy because of side effects with this regimen. Conclusions: Adjunctive antibiotic therapy may increase the effectiveness of BU surgical treatment, and this should be further assessed by larger randomised controlled trials. The combination of rifampicin and ciprofloxacin appears the most promising.

Successful Outcomes with Oral Fluoroquinolones Combined with Rifampicin in the Treatment of Mycobacterium ulcerans: An Observational Cohort Study

“…In addition, the complications mainly involved gastrointestinal intolerance with no significant sequelae. This differs from the significant incidence of serious adverse events previously described for alternative antibiotics such as streptomycin [5], [28] and amikacin [6]. It is important to note that the complication rates were higher in our study compared to studies from African populations [4], [5], [7].…”

“…One case remained positive after 36 days of antibiotics but still achieved cure, reinforcing findings from previous studies that a small proportion of cases may remain culture positive after 1–2 months of antibiotics but still achieve cure with at least 8 weeks of antibiotics [4], [5]. The proportion of patients receiving antibiotic treatment significantly increased from 2005 as it became apparent in patients treated at Barwon Health that antibiotics were associated with a reduction in disease recurrences and permitted more conservative surgery to be performed [6].…”

“…This resulted from clinical experience supported by scientific data showing superior outcomes when antibiotics were used alone [4], [5], or combined with surgery [6], [7]. It is also supported by in vitro data [8]–[10] of antibiotic effectiveness against M. ulcerans .…”

Mycobacterium ulcerans Disease: Experience with Primary Oral Medical Therapy in an Australian Cohort

“…The anatomical location of a M. ulcerans lesion was described as distal if it was on the elbow or below, or on the knee or below [7], [10].…”

Treating Mycobacterium ulcerans disease (Buruli ulcer): from surgery to antibiotics, is the pill mightier than the knife?

“…The initial lesion size was also smaller in the placebo group. A retrospective study in Australia found that use of RIF plus ciprofloxacin significantly improved the outcome from surgical treatment [82]. Use of antibiotics alone in four patients was not successful.…”