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
Int J Tuberc Lung Dis. 2017 February 1; Volume 21 (Issue 2); 167-174.; DOI:10.5588/ijtld.16.0493
Guglielmetti L, Hewison CCH, Avaliani Z, Hughes AJ, Kiria N, et al.
Int J Tuberc Lung Dis. 2017 February 1; Volume 21 (Issue 2); 167-174.; DOI:10.5588/ijtld.16.0493
BACKGROUND
For the first time in almost 50 years, there are new drugs available for the treatment of tuberculosis (TB), including bedaquiline (BDQ) and delamanid (DLM). The rate of introduction, however, has not kept pace with patient needs. It is estimated that as many as 23% of multidrug-resistant TB (MDR-TB) patients have an indication for receiving BDQ. As this is the first time the MDR-TB community is introducing new medications, it is important to understand how implementation can be developed in a variety of settings.
METHODS
A qualitative assessment of country TB programs in which more than 5% of MDR-TB patients were started on BDQ under program conditions.
RESULTS
National TB programs in Belarus, France, Georgia, South Africa, and Swaziland all started sizeable cohorts of patients on BDQ in 2015. Common factors observed in these programs included experience with compassionate use/expanded access, support from implementing partners, and adequate national or donor-supported budgets. Barriers to introduction included restriction of BDQ to the in-patient setting, lack of access to companion drugs, and the development of systems for pharmacovigilance.
CONCLUSION
The five countries in this paper are examples of the introduction of new therapeutic options for the treatment of TB.
For the first time in almost 50 years, there are new drugs available for the treatment of tuberculosis (TB), including bedaquiline (BDQ) and delamanid (DLM). The rate of introduction, however, has not kept pace with patient needs. It is estimated that as many as 23% of multidrug-resistant TB (MDR-TB) patients have an indication for receiving BDQ. As this is the first time the MDR-TB community is introducing new medications, it is important to understand how implementation can be developed in a variety of settings.
METHODS
A qualitative assessment of country TB programs in which more than 5% of MDR-TB patients were started on BDQ under program conditions.
RESULTS
National TB programs in Belarus, France, Georgia, South Africa, and Swaziland all started sizeable cohorts of patients on BDQ in 2015. Common factors observed in these programs included experience with compassionate use/expanded access, support from implementing partners, and adequate national or donor-supported budgets. Barriers to introduction included restriction of BDQ to the in-patient setting, lack of access to companion drugs, and the development of systems for pharmacovigilance.
CONCLUSION
The five countries in this paper are examples of the introduction of new therapeutic options for the treatment of TB.
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.