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


METHODS
Observational, non-randomised study with data collected prospectively or through medical record review.


METHODS
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.


METHODS
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.
O'Brien
Daniel P
DP
Barwon Health, Geelong, Victoria, Australia. daniel.obrien@amsterdam.msf.org
Hughes
Andrew J
AJ
Cheng
Allen C
AC
Henry
Margaret J
MJ
Callan
Peter
P
McDonald
Anthony
A
Holten
Ian
I
Birrell
Mike
M
Sowerby
John M
JM
Johnson
Paul D R
PD
Athan
Eugene
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D019911:Mycobacterium ulcerans; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D012883:Skin Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D017211:Treatment Failure; D014739:Victoria / Q000453:epidemiology
D000900:Anti-Bacterial Agents