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Six vs eight weeks of antibiotics for small Mycobacterium ulcerans lesions in Australian patients

journal contribution
posted on 2020-05-01, 00:00 authored by Daniel P O’brien, Deb Friedman, Raquel Cowan, Aaron Walton, Eugene AthanEugene Athan
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.

History

Journal

Clinical infectious diseases

Volume

70

Issue

9

Pagination

1993 - 1997

Publisher

Oxford University Press

Location

Oxford, Eng.

ISSN

1058-4838

eISSN

1537-6591

Language

eng

Publication classification

C1 Refereed article in a scholarly journal