Department of Infectious Diseases, Barwon Health, Geelong, Australia.
PLoS Negl Trop Dis. 2013 Jul 18;7(7):e2315. doi: 10.1371/journal.pntd.0002315. Print 2013.
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.
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.
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.
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.
溃疡分枝杆菌（MU）可导致毁容性皮肤损伤，在澳大利亚东南部的贝拉里半岛流行。抗生素单独使用或联合手术治疗时，已被证明对杀菌和预防疾病复发非常有效。我们的治疗方法已经演变为主要使用口服药物治疗。
我们从在 Barwon Health 接受 MU 治疗的前瞻性队列中，描述了那些接受主要药物治疗的患者，这些患者的 MU 病变仅接受抗生素治疗，或联合有限的手术清创。
从 2010 年 10 月 1 日至 2011 年 12 月 31 日，有 43 名患者接受了单纯药物治疗，其中 5 名（12%）患者还接受了有限的手术清创。患者的中位年龄为 50.2 岁，86%为世界卫生组织（WHO）1 类，91%为溃疡性病变。30 名（70%）患者联合使用利福平加利福喷丁，12 名（28%）患者联合使用克拉霉素。抗生素治疗的中位持续时间为 56 天，有 7 名（16%）患者接受的治疗时间少于 56 天。7 名（16%）患者因药物副作用而停止使用一种或多种抗生素。42 名（98%）患者在 12 个月内无复发痊愈，1 名（2%）患者在完成 8 周的抗生素治疗后 4 个月复发。
我们的经验证明了口服利福平为基础的方案对 MU 感染进行初步药物治疗的疗效和安全性。需要进一步研究以确定抗生素治疗的最佳和最短持续时间，以及最有效的抗生素剂量和剂型用于儿童。
