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Antimicrobial Agents and Chemotherapy, November 2007, p. 4029-4035, Vol. 51, No. 11
0066-4804/07/$08.00+0     doi:10.1128/AAC.00175-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Promising Clinical Efficacy of Streptomycin-Rifampin Combination for Treatment of Buruli Ulcer (Mycobacterium ulcerans Disease)

Centre de Dépistage et de Traitement de l'ulcère de Buruli, Pobè, Bénin,¹ Buruli Ulcer Control Programme, Cotonou, Bénin,² Fondation Raoul Follereau, Paris, France,³ University Nantes, Faculty of Pharmacy, F-44093, Inserm, U601, Nantes, France,⁴ Johns Hopkins University School of Medicine, Center for Tuberculosis Research, Baltimore, Maryland⁵

Received 6 February 2007/ Returned for modification 23 March 2007/ Accepted 16 May 2007

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.

Published ahead of print on 25 May 2007.

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