title: Exploration of a standard treatment for Buruli ulcer through a comprehensive analysis of all cases diagnosed in Japan.
abstract: Buruli ulcer (BU) is a refractory skin ulcer caused by Mycobacterium ulcerans or M. ulcerans ssp. shinshuense, a subspecies thought to have originated in Japan or elsewhere in Asia. Although BU occurs most frequently in tropical and subtropical areas such as Africa and Australia, the occurrence in Japan has gradually increased in recent years. The World Health Organization recommends multidrug therapy consisting of a combination of oral rifampicin (RFP) and i.m. streptomycin (SM) for the treatment of BU. However, surgical interventions are often required when chemotherapy alone is ineffective. As a first step in developing a standardized regimen for BU treatment in Japan, we analyzed detailed records of treatments and prognoses in 40 of the 44 BU cases that have been diagnosed in Japan. We found that a combination of RFP (450 mg/day), levofloxacin (LVFX; 500 mg/day) and clarithromycin (CAM; at a dose of 800 mg/day instead of 400 mg/day) was superior to other chemotherapies performed in Japan. This simple treatment with oral medication increases the probability of patient adherence, and may often eliminate the need for surgery.
authors: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.|West Yokohama Sugawara Dermatology Clinic, Yokohama, Japan.
authors: Mariko
authors: M
authors: Sugawara
authors: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.|Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Norihisa
authors: N
authors: Ishii
authors: Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Kazue
authors: K
authors: Nakanaga
authors: Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Koichi
authors: K
authors: Suzuki
authors: Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
authors: Yoshihiro
authors: Y
authors: Umebayashi
authors: Tsubasa Home Care Clinic, Funabashi, Japan.
authors: Kuniko
authors: K
authors: Makigami
authors: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors: Michiko
authors: M
authors: Aihara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D054312:Buruli Ulcer / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007564:Japan; D064704:Levofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D017291:Clarithromycin; D012293:Rifampin
keywords: Buruli ulcer; Mycobacterium ulcerans; clarithromycin; levofloxacin; rifampicin; treatment