Journal Article > ResearchFull Text
J Med Case Rep. 2008 June 1; Volume 2 (Issue 1); DOI:10.1186/1752-1947-2-123
O'Brien DP, Athan E, Hughes AJ, Johnson PD
J Med Case Rep. 2008 June 1; Volume 2 (Issue 1); DOI:10.1186/1752-1947-2-123
ABSTRACT: INTRODUCTION: Treatment for osteomyelitis-complicating Mycobacterium ulcerans infection typically requires extensive surgery and even amputation, with no reported benefit from adjunctive antibiotics. CASE PRESENTATION: We report a case of an 87-year-old woman with M. ulcerans osteomyelitis that resolved following limited surgical debridement and 6 months of therapy with rifampicin and ciprofloxacin. CONCLUSION: M. ulcerans osteomyelitis can be successfully treated with limited surgical debridement and adjunctive oral antibiotics.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2015 February 6; Volume 9 (Issue 2); DOI:10.1371/journal.pntd.0003503
Cowan R, Athan E, Friedman ND, Hughes AJ, McDonald AH, et al.
PLoS Negl Trop Dis. 2015 February 6; Volume 9 (Issue 2); DOI:10.1371/journal.pntd.0003503
Journal Article > ResearchFull Text
PLOS One. 2013 July 23; Volume 8 (Issue 7); DOI:10.1371/journal.pone.0068445
Marshall C, Curtis A, Spelman T, O'Brien DP, Greig J, et al.
PLOS One. 2013 July 23; Volume 8 (Issue 7); DOI:10.1371/journal.pone.0068445
To identify associations between specific WHO stage 3 and 4 conditions diagnosed after ART initiation and all cause mortality for patients in resource-limited settings (RLS). DESIGN, SETTING: Analysis of routine program data collected prospectively from 25 programs in eight countries between 2002 and 2010.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2015 February 6; Volume 9 (Issue 2); e0003503.; DOI:https://doi.org/10.1371/journal.pntd.0003503
Cowan R, Athan E, Friedman ND, Hughes AJ, McDonald AH, et al.
PLoS Negl Trop Dis. 2015 February 6; Volume 9 (Issue 2); e0003503.; DOI:https://doi.org/10.1371/journal.pntd.0003503
INTRODUCTION
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.
METHODOLOGY/PRINCIPAL FINDINGS
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.
CONCLUSION
In selected patients, antibiotic treatment durations for M. ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes.
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.
METHODOLOGY/PRINCIPAL FINDINGS
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.
CONCLUSION
In selected patients, antibiotic treatment durations for M. ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes.