Buruli ulcer medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{About1|Mycobacterium ulcerans}} | |||
{{Buruli ulcer}} | {{Buruli ulcer}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Antibiotics currently play little part in the treatment of Buruli ulcer. Recommended drugs include rifampin, streptomycin and dapsone. | Antibiotics currently play little part in the treatment of [[Buruli ulcer]]. Recommended drugs include rifampin, streptomycin and dapsone. | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Acute Pharmacotherapy=== | ===Acute Pharmacotherapy=== | ||
The [[World Health Organisation|WHO]] currently recommend [[rifampicin]] and [[streptomycin]] for eight weeks in the hope of reducing the need for surgery. The combination of rifampicin and [[clarithromycin]] has been used for many years in Australia. Rifampicin must never be used alone because the bacterium quickly becomes resistant. | The [[World Health Organisation|WHO]] currently recommend [[rifampicin]] and [[streptomycin]] for eight weeks in the hope of reducing the need for surgery. The combination of rifampicin and [[clarithromycin]] has been used for many years in Australia. Rifampicin must never be used alone because the bacterium quickly becomes resistant<ref>{{cite journal | author=Sizaire V, Nackers F, Comte E, Portaels F | title=Mycobacterium ulcerans infection: control, diagnosis, and treatment | journal=Lancet Infect Dis | year=2006 | volume=6 | issue=5 | pages=288–296 | id=PMID 16631549 | doi=10.1016/S1473-3099(06)70464-9 | url=http://linkinghub.elsevier.com/retrieve/pii/S1473-3099(06)70464-9 }}</ref>. | ||
There are a number of experimental treatments currently being investigated: | There are a number of experimental treatments currently being investigated: | ||
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In a small series of eight patients, local heat at 40°C led to complete healing without surgery (except the initial removal of dead tissue).<ref>{{cite journal | author=Meyers WM, Shelly WM, Connor DH | title=Heat treatment of ''Mycobacterium ulcerans'' infections without surgical excision | journal=Am J Trop Med Hyg | year=1974 | volume=23 | pages=924–29 }}</ref> | In a small series of eight patients, local heat at 40°C led to complete healing without surgery (except the initial removal of dead tissue).<ref>{{cite journal | author=Meyers WM, Shelly WM, Connor DH | title=Heat treatment of ''Mycobacterium ulcerans'' infections without surgical excision | journal=Am J Trop Med Hyg | year=1974 | volume=23 | pages=924–29 }}</ref> | ||
===Antimicrobial Regimen=== | |||
:* [[Mycobacterium ulcerans]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref> | |||
:* 1. '''Preulcerative lesions''' | |||
::* Excision and primary closure, [[Rifampin]] monotherapy, or heat therapy | |||
:* 2. '''Established ulcers''' | |||
::* Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice | |||
:* 3. '''Control complications of the ulcer''' | |||
::* Preferred regimen: [[Clarithromycin]] {{and}} [[Rifampin]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Neglected diseases]] | [[Category:Neglected diseases]] | ||
Latest revision as of 17:17, 18 September 2017
This page is about clinical aspects of the disease. For microbiologic aspects of the causative organism(s), see Mycobacterium ulcerans.
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Risk calculators and risk factors for Buruli ulcer medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Antibiotics currently play little part in the treatment of Buruli ulcer. Recommended drugs include rifampin, streptomycin and dapsone.
Medical Therapy
Acute Pharmacotherapy
The WHO currently recommend rifampicin and streptomycin for eight weeks in the hope of reducing the need for surgery. The combination of rifampicin and clarithromycin has been used for many years in Australia. Rifampicin must never be used alone because the bacterium quickly becomes resistant[1].
There are a number of experimental treatments currently being investigated:
- Sitafloxacin and rifampicin is a synergistic combination that only been trialled in mice.
- Rifalazil is a rifamycin antibiotic that appears to be more potent than rifampicin that has only been trialled in mice.
- Epiroprim and dapsone are synergistic when used in combination (in vitro studies only at present)
- Diarylquinoline shows high potency in vitro
In a small series of eight patients, local heat at 40°C led to complete healing without surgery (except the initial removal of dead tissue).[2]
Antimicrobial Regimen
- 1. Preulcerative lesions
- Excision and primary closure, Rifampin monotherapy, or heat therapy
- 2. Established ulcers
- Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice
- 3. Control complications of the ulcer
- Preferred regimen: Clarithromycin AND Rifampin
References
- ↑ Sizaire V, Nackers F, Comte E, Portaels F (2006). "Mycobacterium ulcerans infection: control, diagnosis, and treatment". Lancet Infect Dis. 6 (5): 288&ndash, 296. doi:10.1016/S1473-3099(06)70464-9. PMID 16631549.
- ↑ Meyers WM, Shelly WM, Connor DH (1974). "Heat treatment of Mycobacterium ulcerans infections without surgical excision". Am J Trop Med Hyg. 23: 924&ndash, 29.
- ↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.