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Mycobacterium ulcerans treatment - can antibiotic duration be reduced in selected patients?

Cowan, Raquel, Athan, Eugene, Friedman, N. Deborah, Hughes, Andrew J., McDonald, Anthony, Callan, Peter, Fyfe, Janet and O'Brien, Daniel P. 2015, Mycobacterium ulcerans treatment - can antibiotic duration be reduced in selected patients?, PLoS neglected tropical diseases, vol. 9, no. 2, Article number: e0003503, pp. 1-12, doi: 10.1371/journal.pntd.0003503.

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Title Mycobacterium ulcerans treatment - can antibiotic duration be reduced in selected patients?
Author(s) Cowan, Raquel
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Friedman, N. Deborah
Hughes, Andrew J.
McDonald, Anthony
Callan, Peter
Fyfe, Janet
O'Brien, Daniel P.
Journal name PLoS neglected tropical diseases
Volume number 9
Issue number 2
Season Article number: e0003503
Start page 1
End page 12
Total pages 12
Publisher Public Library of Science
Place of publication San Francisco, Calif.
Publication date 2015-02-06
ISSN 1935-2727
1935-2735
Summary Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessation and local experience suggests that shorter antibiotic courses may be effective with concurrent surgery. We report the outcomes of patients in the Barwon Health M. ulcerans cohort who received shorter courses of antibiotic therapy than 8 weeks. A retrospective analysis was performed of all M. ulcerans infections treated at Barwon Health from March 1, 1998 to July 31, 2013. Sixty-two patients, with a median age of 65 years, received < 56 days of antibiotics and 51 (82%) of these patients underwent concurrent surgical excision. Most received a two-drug regimen of rifampicin combined with either ciprofloxacin or clarithromycin for a median 29 days (IQR 21–41days). Cessation rates were 55% for adverse events and 36% based on clinician decision. The overall success rate was 95% (98% with concurrent surgery; 82% with antibiotics alone) with a 50% success rate for those who received < 14 days of antibiotics increasing to 94% if they received 14–27 days and 100% for 28–55 days (p<0.01). A 100% success rate was seen for concurrent surgery and 14–27 days of antibiotics versus 67% for concurrent surgery and < 14 days of antibiotics (p = 0.12). No previously identified risk factors for treatment failure with surgery alone were associated with reduced treatment success rates with < 56 days of antibiotics. In selected patients, antibiotic treatment durations for M. ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes.
Language eng
DOI 10.1371/journal.pntd.0003503
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30086590

Document type: Journal Article
Collections: School of Medicine
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.