title: Mycobacterium ulcerans disease: experience with primary oral medical therapy in an Australian cohort.
abstract: BACKGROUND
  Mycobacterium ulcerans (MU) is responsible for disfiguring skin lesions and is endemic on the Bellarine peninsula of southeastern Australia. Antibiotics have been shown to be highly effective in sterilizing lesions and preventing disease recurrences when used alone or in combination with surgery. Our practice has evolved to using primarily oral medical therapy.
  
  
  METHODS
  From a prospective cohort of MU patients managed at Barwon Health, we describe those treated with primary medical therapy defined as treatment of a M. ulcerans lesion with antimicrobials either alone or in conjunction with limited surgical debridement.
  
  
  RESULTS
  From 1/10/2010 through 31/12/11, 43 patients were treated with exclusive medical therapy, of which 5 (12%) also underwent limited surgical debridement. The median patient age was 50.2 years, and 86% had WHO category 1 and 91% ulcerative lesions. Rifampicin was combined with ciprofloxacin in 30 (70%) and clarithromycin in 12 (28%) patients. The median duration of antibiotic therapy was 56 days, with 7 (16%) receiving less than 56 days. Medication side effects requiring cessation of one or more antibiotics occurred in 7 (16%) patients. Forty-two (98%) patients healed without recurrence within 12 months, and 1 patient (2%) experienced a relapse 4 months after completion of 8 weeks of antimicrobial therapy.
  
  
  CONCLUSIONS
  Our experience demonstrates the efficacy and safety of primary oral medical management of MU infection with oral rifampicin-based regimens. Further research is required to determine the optimal and minimum durations of antibiotic therapy, and the most effective antibiotic dosages and formulations for young children.
authors.affiliation: Department of Infectious Diseases, Barwon Health, Geelong, Australia. Deborahf@barwonhealth.org.au
authors.forename: N Deborah
authors.initials: ND
authors.lastname: Friedman
authors.forename: Eugene
authors.initials: E
authors.lastname: Athan
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hughes
authors.forename: Masoomeh
authors.initials: M
authors.lastname: Khajehnoori
authors.forename: Anthony
authors.initials: A
authors.lastname: McDonald
authors.forename: Peter
authors.initials: P
authors.lastname: Callan
authors.forename: Richard
authors.initials: R
authors.lastname: Rahdon
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Brien
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001315:Australia; D054312:Buruli Ulcer / Q000188:drug therapy* / Q000601:surgery; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000009:adverse effects; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003646:Debridement; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019911:Mycobacterium ulcerans / Q000302:isolation & purification*; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D017291:Clarithromycin; D012293:Rifampin