01999nas a2200253   4500000000100000008004100001260001200042653001700054653002700071653002000098653002100118653001700139653001400156100001900170700001400189700001500203700001500218700001600233245004400249856007100293300000900364520135800373022001401731       2020                            d  c04/202010aBuruli ulcer10aMycobacterium ulcerans10aclinical trials10apharmacokinetics10apharmacology10atreatment1 aVan Der Werf T1 aBarogui Y1 aConverse P1 aPhillips R1 aStienstra Y00aPharmacologic management of  infection.  uhttps://www.tandfonline.com/doi/full/10.1080/17512433.2020.1752663  a1-113 a<p>: Pharmacological treatment of Buruli ulcer ( infection; BU) is highly effective, as shown in two randomized trials in Africa.: We review BU drug treatment - in vitro, in vivo and clinical trials (PubMed: '(Buruli OR (Mycobacterium AND ulcerans)) AND (treatment OR therapy).' We also highlight the pathogenesis of  infection that is dominated by mycolactone, a secreted exotoxin, that causes skin and soft tissue necrosis, and impaired immune response and tissue repair. Healing is slow, due to the delayed wash-out of mycolactone. An array of repurposed tuberculosis and leprosy drugs appears effective in vitro and in animal models. In clinical trials and observational studies, only rifamycins (notably, rifampicin), macrolides (notably, clarithromycin), aminoglycosides (notably, streptomycin) and fluoroquinolones (notably, moxifloxacin, and ciprofloxacin) have been tested.: A combination of rifampicin and clarithromycin is highly effective but lesions still take a long time to heal. Novel drugs like telacebec have the potential to reduce treatment duration but this drug may remain unaffordable in low-resourced settings. Research should address ulcer treatment in general; essays to measure mycolactone over time hold promise to use as a readout for studies to compare drug treatment schedules for larger lesions of Buruli ulcer.</p>  a1751-2441