Chauty Annick, Ardant Marie-Françoise, Adeye Ambroise, Euverte Hélène, Guédénon Augustin, Johnson Christian, Aubry Jacques, Nuermberger Eric, Grosset Jacques
Centrr de Dépistage et de Traitement de l'ulcère de Buruli, Pobè, Bénin.
Antimicrob Agents Chemother. 2007 Nov;51(11):4029-35. doi: 10.1128/AAC.00175-07. Epub 2007 May 25.
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.
根据世界卫生组织布鲁里溃疡咨询委员会第六届会议的建议，向贝宁波贝确诊患有布鲁里溃疡的310名患者推荐了利福平和链霉素联合的直接观察治疗，每日给药，持续8周。在开始治疗的224名（72%）符合条件的患者中，215名（96%）被归类为治疗成功，9名治疗失败，其中包括1例死亡和8例失访。在215名成功治疗的患者中，102名（47%）仅接受抗生素治疗，113名（53%）接受抗生素加手术切除和植皮治疗。治疗开始时病变的大小是与手术干预相关的主要因素：直径>15 cm病变的患者中有73%接受了手术，而直径<5 cm病变的患者中只有17%接受了手术。没有患者因抗生素治疗的副作用而停药。停止治疗一年后，对215名患者中的208名进行了积极回访以评估长期治疗效果：在回访的208名患者中，3名（1.44%）出现溃疡分枝杆菌病复发，其中仅接受抗生素治疗的107名患者中有2名，接受抗生素加手术治疗的108名患者中有一名。我们得出结论，世界卫生组织推荐的链霉素-利福平联合疗法对治疗溃疡分枝杆菌病非常有效。单纯化疗在47%的病例中成功治愈，对直径小于5 cm的溃疡特别有效。
