03057nas a2200457   4500000000100000008004100001653002200042653001300064653002600077653002700103653001600130653000900146653001100155653001100166653005200177653003000229653001600259653001900275653001900294653001800313653001700331653001400348653002600362653000900388653001000397653002500407100001500432700001200447700001300459700001800472700001500490700001300505700001300518700001500531245010600546856011600652300001000768490000600778520180100784022001402585       2013                            d10aTreatment Outcome10aRifampin10aRetrospective Studies10aMycobacterium ulcerans10aMiddle Aged10aMale10aHumans10aFemale10aDrug-Related Side Effects and Adverse Reactions10aDrug Therapy, Combination10aDebridement10aCohort Studies10aClarithromycin10aCiprofloxacin10aBuruli ulcer10aAustralia10aAnti-Bacterial Agents10aAged10aAdult10aAdministration, Oral1 aFriedman D1 aAthan E1 aHughes A1 aKhajehnoori M1 aMcDonald A1 aCallan P1 aRahdon R1 aO'Brien DP00aMycobacterium ulcerans disease: experience with primary oral medical therapy in an Australian cohort.  uhttp://www.plosntds.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pntd.0002315&representation=PDF  ae23150 v73 a<p><strong>BACKGROUND: </strong>Mycobacterium ulcerans (MU) is responsible for disfiguring skin lesions and is endemic on the Bellarine peninsula of southeastern Australia. Antibiotics have been shown to be highly effective in sterilizing lesions and preventing disease recurrences when used alone or in combination with surgery. Our practice has evolved to using primarily oral medical therapy.</p>

<p><strong>METHODS: </strong>From a prospective cohort of MU patients managed at Barwon Health, we describe those treated with primary medical therapy defined as treatment of a M. ulcerans lesion with antimicrobials either alone or in conjunction with limited surgical debridement.</p>

<p><strong>RESULTS: </strong>From 1/10/2010 through 31/12/11, 43 patients were treated with exclusive medical therapy, of which 5 (12%) also underwent limited surgical debridement. The median patient age was 50.2 years, and 86% had WHO category 1 and 91% ulcerative lesions. Rifampicin was combined with ciprofloxacin in 30 (70%) and clarithromycin in 12 (28%) patients. The median duration of antibiotic therapy was 56 days, with 7 (16%) receiving less than 56 days. Medication side effects requiring cessation of one or more antibiotics occurred in 7 (16%) patients. Forty-two (98%) patients healed without recurrence within 12 months, and 1 patient (2%) experienced a relapse 4 months after completion of 8 weeks of antimicrobial therapy.</p>

<p><strong>CONCLUSION: </strong>Our experience demonstrates the efficacy and safety of primary oral medical management of MU infection with oral rifampicin-based regimens. Further research is required to determine the optimal and minimum durations of antibiotic therapy, and the most effective antibiotic dosages and formulations for young children.</p>
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