title: 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.
  
  
  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.
authors.affiliation: Barwon Health, Geelong, Victoria, Australia. daniel.obrien@amsterdam.msf.org
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Brien
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hughes
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Henry
authors.forename: Peter
authors.initials: P
authors.lastname: Callan
authors.forename: Anthony
authors.initials: A
authors.lastname: McDonald
authors.forename: Ian
authors.initials: I
authors.lastname: Holten
authors.forename: Mike
authors.initials: M
authors.lastname: Birrell
authors.forename: John M
authors.initials: JM
authors.lastname: Sowerby
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.forename: Eugene
authors.initials: E
authors.lastname: Athan
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents