title: Clinical outcomes of Ghanaian Buruli ulcer patients who defaulted from antimicrobial therapy.
abstract: Buruli ulcer (BU) is a tropical skin disease caused by infection with Mycobacterium ulcerans, which is currently treated with 8 weeks of streptomycin and rifampicin. The evidence to treat BU for a duration of 8 weeks is limited; a recent retrospective study from Australia suggested that a shorter course of antimicrobial therapy might be equally effective. We studied the outcomes of BU in a cohort of Ghanaian patients who defaulted from treatment and as such received less than 8 weeks of antimicrobial therapy.
  
  
  
  A number of days of antimicrobial therapy and patient and lesion characteristics were recorded from charts from a cohort of BU patients treated at Nkawie-Toase hospital between 2008 and 2012. Patients who defaulted from treatment were retrieved, and lesion characteristics and functional limitations were recorded.
  
  
  
  About 54% of patients defaulted from therapy or wound care. Forty-seven defaulters with follow-up completed had received <56 days of antibiotics. 84% of these patients healed after 32 days or less of antibiotics. There appeared to be an increased rate of healing in smaller lesions; 94% of WHO category I lesions had healed after 32 days or less of antibiotics.
  
  
  
  Although numbers were small, and a potential for bias exists, our findings suggest that a reduction in the duration of antimicrobial therapy in BU in small, early lesions is feasible. These findings can serve as a basis for future well-designed studies.
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Klis
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Kingma
authors.affiliation: Buruli Ulcer Clinic, Nkawie-Toase Government Hospital, Nkawie-Toase, Ghana.
authors.forename: W
authors.initials: W
authors.lastname: Tuah
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.|Department of Pulmonary Medicine, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.
authors.forename: T S
authors.initials: TS
authors.lastname: van der Werf
authors.affiliation: Department of Internal Medicine, University Medical Center Groningen, Groningen University, Groningen, The Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Stienstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D054312:Buruli Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005869:Ghana; D006761:Hospitals; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D019911:Mycobacterium ulcerans; D012293:Rifampin / Q000008:administration & dosage* / Q000627:therapeutic use; D013307:Streptomycin / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin; D013307:Streptomycin
keywords: Buruli ulcer; Mycobacterium ulcerans; antimicrobial therapy; compliance du patient; cumplimiento del paciente; patient compliance; terapia antimicrobiana; traitement antimicrobien; ulcère de Buruli; úlcera de Buruli