Outcomes for Mycobacterium ulcerans infection with combined surgery and antibiotic therapy: findings from a south-eastern Australian case series.

Hdl Handle:
http://hdl.handle.net/10144/17726
Title:
Outcomes for Mycobacterium ulcerans infection with combined surgery and antibiotic therapy: findings from a south-eastern Australian case series.
Authors:
O'Brien, D P; Hughes, A; Cheng, A C; Henry, M J; Callan, P; McDonald, A; Holten, I; Birrell, M; Sowerby, J M; Johnson, P D; Athan, E
Journal:
The Medical Journal of Australia
Abstract:
OBJECTIVE: To describe the effect of antibiotics on outcomes of treatment for Buruli or Bairnsdale ulcer (BU) in patients on the Bellarine Peninsula in south-eastern Australia. DESIGN: Observational, non-randomised study with data collected prospectively or through medical record review. PATIENTS AND SETTING: All 40 patients with BU managed by staff of Barwon Health's Geelong Hospital (a public, secondary-level hospital) between 1 January 1998 and 31 December 2004. MAIN OUTCOME MEASURES: Epidemiology, clinical presentation, diagnosis, treatment and clinical outcomes. RESULTS: There were 59 treatment episodes; 29 involved surgery alone, 26 surgery plus antibiotics, and four antibiotics alone. Of 55 episodes where surgery was performed, minor surgery was required in 22, and major surgery in 33. Failure rates were 28% for surgery alone, and 19% for surgery plus antibiotics. Adjunctive antibiotic therapy was associated with increased treatment success for lesions with positive histological margins (P < 0.01), and lesions requiring major surgery for treatment of a first episode (P < 0.01). The combination of rifampicin and ciprofloxacin resulted in treatment success in eight of eight episodes, and no patients ceased therapy because of side effects with this regimen. CONCLUSIONS: Adjunctive antibiotic therapy may increase the effectiveness of BU surgical treatment, and this should be further assessed by larger randomised controlled trials. The combination of rifampicin and ciprofloxacin appears the most promising.
Affiliation:
Barwon Health, Geelong, Victoria, Australia. daniel.obrien@amsterdam.msf.org
Publisher:
Medical Society of Australia
Issue Date:
15-Jan-2007
PubMed ID:
17223763
Additional Links:
http://www.mja.com.au/public/issues/186_02_150107/obr10433_fm.pdf
Language:
en
Description:
To access this article, click on "Additional Links"
ISSN:
0025-729X
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorO'Brien, D P-
dc.contributor.authorHughes, A-
dc.contributor.authorCheng, A C-
dc.contributor.authorHenry, M J-
dc.contributor.authorCallan, P-
dc.contributor.authorMcDonald, A-
dc.contributor.authorHolten, I-
dc.contributor.authorBirrell, M-
dc.contributor.authorSowerby, J M-
dc.contributor.authorJohnson, P D-
dc.contributor.authorAthan, E-
dc.date.accessioned2008-02-07T16:37:55Z-
dc.date.available2008-02-07T16:37:55Z-
dc.date.issued2007-01-15-
dc.identifier.citationOutcomes for Mycobacterium ulcerans infection with combined surgery and antibiotic therapy: findings from a south-eastern Australian case series. 2007, 186 (2):58-61 Med. J. Aust.en
dc.identifier.issn0025-729X-
dc.identifier.pmid17223763-
dc.descriptionTo access this article, click on "Additional Links"-
dc.description.abstractOBJECTIVE: To describe the effect of antibiotics on outcomes of treatment for Buruli or Bairnsdale ulcer (BU) in patients on the Bellarine Peninsula in south-eastern Australia. DESIGN: Observational, non-randomised study with data collected prospectively or through medical record review. PATIENTS AND SETTING: All 40 patients with BU managed by staff of Barwon Health's Geelong Hospital (a public, secondary-level hospital) between 1 January 1998 and 31 December 2004. MAIN OUTCOME MEASURES: Epidemiology, clinical presentation, diagnosis, treatment and clinical outcomes. RESULTS: There were 59 treatment episodes; 29 involved surgery alone, 26 surgery plus antibiotics, and four antibiotics alone. Of 55 episodes where surgery was performed, minor surgery was required in 22, and major surgery in 33. Failure rates were 28% for surgery alone, and 19% for surgery plus antibiotics. Adjunctive antibiotic therapy was associated with increased treatment success for lesions with positive histological margins (P < 0.01), and lesions requiring major surgery for treatment of a first episode (P < 0.01). The combination of rifampicin and ciprofloxacin resulted in treatment success in eight of eight episodes, and no patients ceased therapy because of side effects with this regimen. CONCLUSIONS: Adjunctive antibiotic therapy may increase the effectiveness of BU surgical treatment, and this should be further assessed by larger randomised controlled trials. The combination of rifampicin and ciprofloxacin appears the most promising.en
dc.language.isoenen
dc.publisherMedical Society of Australia-
dc.relation.urlhttp://www.mja.com.au/public/issues/186_02_150107/obr10433_fm.pdf-
dc.rightsArchived on this site with thanks to the Medical Society of Australiaen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshAged, 80 and overen
dc.subject.meshAnti-Bacterial Agentsen
dc.subject.meshAntibiotic Prophylaxisen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshCombined Modality Therapyen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshMycobacterium Infections, Atypicalen
dc.subject.meshMycobacterium ulceransen
dc.subject.meshRetrospective Studiesen
dc.subject.meshSkin Diseases, Bacterialen
dc.subject.meshSkin Ulceren
dc.subject.meshTreatment Failureen
dc.subject.meshVictoriaen
dc.titleOutcomes for Mycobacterium ulcerans infection with combined surgery and antibiotic therapy: findings from a south-eastern Australian case series.en
dc.contributor.departmentBarwon Health, Geelong, Victoria, Australia. daniel.obrien@amsterdam.msf.orgen
dc.identifier.journalThe Medical Journal of Australiaen

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