Treatment
Treatment is by surgical excision (removal) of the lesion, which may be only a minor operation and very successful if undertaken early. Advanced disease may require prolonged treatment with extensive skin grafting. Surgical practice can be dangerous and scarcely available in affected third world countries.
Antibiotics currently play little part in the treatment of Buruli ulcer. The WHO currently recommend rifampicin and streptomycin for eight weeks in the hope of reducing the need for surgery. The combination of rifampicin and clarithromycin has been used for many years in Australia. Rifampicin must never be used alone because the bacterium quickly becomes resistant.
There are a number of experimental treatments currently being investigated:
- Sitafloxacin and rifampicin is a synergistic combination that has only been trialled in mice.
- Rifalazil is a rifamycin antibiotic that appears to be more potent than rifampicin that has only been trialled in mice.
- Epiroprim and dapsone are synergistic when used in combination (in vitro studies only at present)
- Diarylquinoline shows high potency in vitro
- Application of French clay.
In a small series of eight patients, local heat at 40°C led to complete healing without surgery (except the initial removal of dead tissue).
Read more about this topic: Buruli Ulcer
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