title: Promising clinical efficacy of streptomycin-rifampin combination for treatment of buruli ulcer (Mycobacterium ulcerans disease).
abstract: According to recommendations of the 6th WHO Advisory Committee on Buruli ulcer, directly observed treatment with the combination of rifampin and streptomycin, administered daily for 8 weeks, was recommended to 310 patients diagnosed with Buruli ulcer in Pobè, Bénin. Among the 224 (72%) eligible patients for whom treatment was initiated, 215 (96%) were categorized as treatment successes, and 9, including 1 death and 8 losses to follow-up, were treatment failures. Of the 215 successfully treated patients, 102 (47%) were treated exclusively with antibiotics and 113 (53%) were treated with antibiotics plus surgical excision and skin grafting. The size of lesions at treatment initiation was the major factor associated with surgical intervention: 73% of patients with lesions of >15 cm in diameter underwent surgery, whereas only 17% of patients with lesions of <5 cm had surgery. No patient discontinued therapy for side effects from the antibiotic treatment. One year after stopping treatment, 208 of the 215 patients were actively retrieved to assess the long-term therapeutic results: 3 (1.44%) of the 208 retrieved patients had recurrence of Mycobacterium ulcerans disease, 2 among the 107 patients treated only with antibiotics and 1 among the 108 patients treated with antibiotics plus surgery. We conclude that the WHO-recommended streptomycin-rifampin combination is highly efficacious for treating M. ulcerans disease. Chemotherapy alone was successful in achieving cure in 47% of cases and was particularly effective against ulcers of less than 5 cm in diameter.
authors.affiliation: Centrr de Dépistage et de Traitement de l'ulcère de Buruli, Pobè, Bénin.
authors.forename: Annick
authors.initials: A
authors.lastname: Chauty
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Ardant
authors.forename: Ambroise
authors.initials: A
authors.lastname: Adeye
authors.forename: Hélène
authors.initials: H
authors.lastname: Euverte
authors.forename: Augustin
authors.initials: A
authors.lastname: Guédénon
authors.forename: Christian
authors.initials: C
authors.lastname: Johnson
authors.forename: Jacques
authors.initials: J
authors.lastname: Aubry
authors.forename: Eric
authors.initials: E
authors.lastname: Nuermberger
authors.forename: Jacques
authors.initials: J
authors.lastname: Grosset
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D054312:Buruli Ulcer / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000187:drug effects*; D012293:Rifampin / Q000627:therapeutic use*; D013307:Streptomycin / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin