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Antimicrobial Agents and Chemotherapy, August 2005, p. 3182-3186, Vol. 49, No. 8
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.8.3182-3186.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Efficacy of the Combination Rifampin-Streptomycin in Preventing Growth of Mycobacterium ulcerans in Early Lesions of Buruli Ulcer in Humans

S. Etuaful,1 B. Carbonnelle,2 J. Grosset,3 S. Lucas,4 C. Horsfield,4 R. Phillips,5 M. Evans,5 D. Ofori-Adjei,6 E. Klustse,7 J. Owusu-Boateng,8 G. K. Amedofu,9 P. Awuah,9 E. Ampadu,10 G. Amofah,10 K. Asiedu,11 and M. Wansbrough-Jones5*

St. Martin's Catholic Hospital, Agroyesum, Ghana,1 Laboratoire de Bactériologie, CHU (University Hospital) Angers, Angers, France,2 Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland,3 St. Thomas's Hospital Campus, UMDS, London, United Kingdom,4 St. George's Hospital Medical School, London, United Kingdom,5 Noguchi Memorial Institute for Medical Research, Accra, Ghana,6 Dunkwa Government Hospital, Dunkwa-on-Offin, Ghana,7 Public Health Reference Laboratory, Kumasi, Ghana,8 Department of Ear, Nose and Throat, Hearing Assessment Center, Komfo Anokye Teaching Hospital, Kumasi, Ghana,9 Ghana Health Service, Public Health Division, Accra, Ghana,10 World Health Organization, Geneva, Switzerland,11

Received 4 March 2005/ Returned for modification 11 April 2005/ Accepted 29 April 2005

Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and three treated for 12 weeks were culture negative. No lesions became enlarged during antibiotic treatment, and most became smaller. Treatment with rifampin and streptomycin for 4 weeks or more inhibited growth of M. ulcerans in human tissue, and it provides a basis for proceeding to a trial of antibiotic therapy as an alternative to surgery for early M. ulcerans disease.

* Corresponding author. Mailing address: St. George's Hospital Medical School, Department of Cellular and Molecular Medicine, Cranmer Terrace, London SW17 0RE, United Kingdom. Phone: 44 2087255827. Fax: 44 2087253487. E-mail: wansbrou{at}sghms.ac.uk.

Antimicrobial Agents and Chemotherapy, August 2005, p. 3182-3186, Vol. 49, No. 8
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.8.3182-3186.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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