Buruli Ulcer Medication

  • Author: Shannon C Brown, MD; Chief Editor: William D James, MD  more...
 
Updated: Sep 13, 2016
 

Medication Summary

The goal of therapy is to reduce morbidity and prevent complications.

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Antibiotics

Rifampin (Rifadin, Rimactane)

 

Rifampin inhibits DNA-dependent bacterial but not mammalian RNA polymerase. Cross-resistance may occur.

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Antibiotic, Quinolone

Ciprofloxacin (Cipro)

 

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. It has no activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.

Moxifloxacin (Avelox, Vigamox)

 

Moxifloxacin inhibits the A subunits of DNA gyrase, resulting in the inhibition of bacterial DNA replication and transcription.

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Antibiotic, Aminoglycoside

Streptomycin sulfate (G-Mycin, Garamycin)

 

Streptomycin sulfate is for the treatment of susceptible mycobacterial infections. Use it in combination with rifampin. Streptomycin sulfate may be used in patients with severe liver dysfunction (transaminase levels >3- to 5-fold normal).

Amikacin (Amikin)

 

Amikacin irreversibly binds to the 30S subunit of bacterial ribosomes; it blocks the recognition step in protein synthesis and causes growth inhibition. Use the patient's ideal body weight for dosage calculation. The same principles of drug monitoring for gentamicin apply to amikacin.

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Antibiotic, Macrolide

Clarithromycin (Biaxin)

 

Clarithromycin is a semisynthetic macrolide antibiotic that reversibly binds to the P site of the 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl t-RNA from ribosomes, causing bacterial growth inhibition.

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Contributor Information and Disclosures
Author

Shannon C Brown, MD Resident Physician, Department of Dermatology, Texas A&M Health Science Center, Baylor Scott and White Health

Shannon C Brown, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Gold Humanism Honor Society, Society for Pediatric Dermatology, Texas Dermatological Society, Texas Medical Association, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kirstin Altman, MD Assistant Professor of Dermatology, Texas A&M Health Science Center College of Medicine

Kirstin Altman, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Texas Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

Aaron Z Hoover, MD, FAAD Staff Dermatologist/Dermatopathologist, Front Range Dermatology Associates

Aaron Z Hoover, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Christian Medical and Dental Associations, International Society of Dermatopathology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Humira.

Acknowledgements

Special thanks to Ms Carmen Urich for helping me obtain articles needed to update this publication.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of the following previous authors, Brian P. Green, DO, MS, PA-C; Sean T. Gunning, MD; and Mary K. Mather, MD, to the development and writing of this article.

The authors and editors of Medscape Reference would also like to thank Wayne M. Meyers, MD, for his clinical images from his article with Douglas S. Walsh, MD, in Transactions of the Royal Society of Tropical Medicine and Hygiene.[4]

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Buruli ulcer can extend to 15% of a person's skin surface and may destroy nerves and blood vessels. Metastatic bone lesions may develop.
An edematous Buruli ulcer in a 9-year-old Togolese girl. Courtesy of Wayne M Meyers, MD.
Photo of Togolese girl taken 5 years after the Buruli ulcer had been excised and repaired with autologous split-skin graft by GB Priuli, MD. Courtesy of Wayne M Meyers, MD.
Well-circumscribed ulceration with sharp, undermined borders on the lower leg. Courtesy of Ronald E Grimwood, Jr, MD, Baylor Scott and White Health.
Table 1. Pros and Cons of Sampling Techniques From the WHO[22]
Method Pros Cons
Direct smear examination• Easy to perform at local level



• Does not require expensive materials and equipment



• Rapid results



• Uses swabs, fine-needle aspiration, and biopsy samples



• Low sensitivity (<60%)



• Needs trained personnel



• Needs external quality assurance



PCR• Results fairly rapid



• Uses swabs, fine-needle aspiration, and biopsy samples



• High sensitivity (>95%)



• Requires a sophisticated laboratory



• Expensive to perform



• Needs trained personnel



• Requires strict quality control



Culture of M ulcerans• Uses swabs, fine-needle aspiration, and biopsy samples• Requires a sophisticated laboratory



• Needs trained personnel



• Results take >8 weeks



• Low sensitivity (20-60%)



• Not useful for immediate patient management



Histopathology• Sensitivity is about 90%



• Results fairly rapid (if services are available)



• Useful in establishing differential diagnosis and monitoring unexpected response to treatment



• Requires a sophisticated laboratory



• Expensive to perform



• Needs trained personnel



• Requires invasive procedure (ie, biopsy)



Table 2. Categories of Treatment[55]
CategoryForm of DiseaseTreatmentPrimary AimSecondary AimLevel of Health Care SystemDiagnosis
ISmall, early lesion (eg, nodules, papules, plaques, ulcers < 5 cm in diameter)Complete antibiotics



If at or near a joint, maintain same movement as on unaffected side



If surgery is needed in noncritical areas, consider this after 8 weeks of antibiotic treatment



Cure without surgery



Cure without movement limitations



Reduce or prevent recurrenceCommunity health centers and district hospitalsStrong clinical diagnosis (with or without laboratory confirmation)
IINonulcerative and ulcerative plaque and edematous forms



Single, large ulcerative lesion 5-15 cm in diameter



Complete antibiotics, before surgery (if possible)



If at or near a joint, maintain same movement as on unaffected side



Cure without surgery



Reduce extent of the surgical debridement when needed



Cure without movement limitations



Reduce or prevent recurrenceHealth centers, district and tertiary hospitalsStrong clinical diagnosis (with or without laboratory confirmation)
IIILesions in the head and neck region, particularly the face



Disseminated/mixed forms (eg, osteitis, osteomyelitis, joint involvement)



Multiple lesions and osteomyelitis



Extensive lesion >15 cm



Complete antibiotics, before surgery (if possible)



If at or near a joint, maintain same movement as on unaffected side



Cure without surgery



Cure without movement limitations



Reduce or prevent recurrenceDistrict and tertiary hospitalsStrong clinical diagnosis (with or without laboratory confirmation)
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