Daniel P O'Brien1,2,3, N Deborah Friedman1, Raquel Cowan1, Aaron Walton1, Eugene Athan1,4. 1. Department of Infectious Diseases, University Hospital Geelong. 2. Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Australia. 3. Manson Unit, Médecins Sans Frontières, London, United Kingdom. 4. School of Medicine, Deakin University, Geelong, Australia.
Abstract
BACKGROUND: Antibiotics are highly effective in curing Mycobacterium ulcerans lesions, but are associated with significant toxicity. In those not undergoing surgery, we compared 6 weeks with the currently recommended 8 weeks of combination antibiotic therapy for small M. ulcerans lesions. METHODS: Mycobacterium ulcerans cases from an observational cohort at Barwon Health, Victoria, treated with antibiotics alone from 1 October 2010 to 31 March 2018 were included. The 6-week antibiotic group received ≥28 days and ≤42 days and the 8-week antibiotic group received ≥56 days of antibiotic therapy, respectively. Only World Health Organization category 1 lesions were included. RESULTS: 207 patients were included; 53 (25.6%) in the 6-week group and 154 (74.4%) in the 8-week group. The median age of patients was 53 years (interquartile range [IQR], 33-69 years) and 100 (48.3%) were female. Lesions were ≤900 mm2 in size in 79.7% of patients and 93.2% were ulcerative. Fifty-three patients (100%) achieved treatment cure in the 6-week group compared with 153 (99.4%) in the 8-week group (P = .56). No patients died or were lost to follow-up during the study. Median time to heal was 70 days (IQR, 60-96 days) in the 6-week group and 128 days (IQR, 95-173 days) in the 8-week group (P < .001). Two (3.8%) patients in the 6-week group experienced a paradoxical reaction compared with 39 (25.3%) patients in the 8-week group (P = .001). CONCLUSIONS: For selected small M. ulcerans lesions, 6 weeks may be as effective as 8 weeks of combined antibiotic therapy in curing lesions without surgery.
BACKGROUND: Antibiotics are highly effective in curing Mycobacterium ulcerans lesions, but are associated with significant toxicity. In those not undergoing surgery, we compared 6 weeks with the currently recommended 8 weeks of combination antibiotic therapy for small M. ulcerans lesions. METHODS: Mycobacterium ulcerans cases from an observational cohort at Barwon Health, Victoria, treated with antibiotics alone from 1 October 2010 to 31 March 2018 were included. The 6-week antibiotic group received ≥28 days and ≤42 days and the 8-week antibiotic group received ≥56 days of antibiotic therapy, respectively. Only World Health Organization category 1 lesions were included. RESULTS: 207 patients were included; 53 (25.6%) in the 6-week group and 154 (74.4%) in the 8-week group. The median age of patients was 53 years (interquartile range [IQR], 33-69 years) and 100 (48.3%) were female. Lesions were ≤900 mm2 in size in 79.7% of patients and 93.2% were ulcerative. Fifty-three patients (100%) achieved treatment cure in the 6-week group compared with 153 (99.4%) in the 8-week group (P = .56). No patients died or were lost to follow-up during the study. Median time to heal was 70 days (IQR, 60-96 days) in the 6-week group and 128 days (IQR, 95-173 days) in the 8-week group (P < .001). Two (3.8%) patients in the 6-week group experienced a paradoxical reaction compared with 39 (25.3%) patients in the 8-week group (P = .001). CONCLUSIONS: For selected small M. ulcerans lesions, 6 weeks may be as effective as 8 weeks of combined antibiotic therapy in curing lesions without surgery.
Authors: Tjip S Van Der Werf; Yves T Barogui; Paul J Converse; Richard O Phillips; Ymkje Stienstra Journal: Expert Rev Clin Pharmacol Date: 2020-04-20 Impact factor: 4.108
Authors: Richard O Phillips; Jérôme Robert; Kabiru Mohamed Abass; William Thompson; Fred Stephen Sarfo; Tuah Wilson; Godfred Sarpong; Thierry Gateau; Annick Chauty; Raymond Omollo; Michael Ochieng Otieno; Thaddaeus W Egondi; Edwin O Ampadu; Didier Agossadou; Estelle Marion; Line Ganlonon; Mark Wansbrough-Jones; Jacques Grosset; John M Macdonald; Terry Treadwell; Paul Saunderson; Albert Paintsil; Linda Lehman; Michael Frimpong; Nanaa Francisca Sarpong; Raoul Saizonou; Alexandre Tiendrebeogo; Sally-Ann Ohene; Ymkje Stienstra; Kingsley B Asiedu; Tjip S van der Werf Journal: Lancet Date: 2020-03-12 Impact factor: 79.321