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[ACCRA] Buruli ulcer experts say they are a step closer to avoiding surgery for the debilitating disease, following a trial published in The Lancet.

Researchers found that Buruli ulcer can be successfully treated with antibiotics alone in most cases — provided doctors catch them early enough.

Buruli ulcer is caused by Mycobacterium ulcerans and leads to permanent disability and disfigurement if not treated in time (see Early diagnosis 'essential' in Buruli ulcer treatment).

The standard treatment was surgery to remove infected tissue and correct deformities. But after a promising pilot study in 2004, the WHO updated its guidelines to recommend additional treatment with the antibiotics streptomycin and rifampicin.

Researchers from Germany, Ghana and the Netherlands — writing in The Lancet this month (4 February) — tested two different antibiotic treatments on 150 Buruli ulcer patients in Ghana.

Roughly half of the group was given streptomycin injections and oral rifampicin for eight weeks. The other half was given streptomycin and rifampicin for four weeks, followed by oral rifampicin and clarithromycin for four weeks.

After one year, the ulcers of more than 90 per cent of patients in both groups had healed and no patients' ulcers came back. Just five patients needed extensive surgery.

The study is not the first to test the use of antibiotics alone. However, aside from the 2004 pilot study, such trials have been observational.

In an accompanying comment in The Lancet, Paul Johnson of the Department of Infectious Diseases at Austin Health and the University of Melbourne, Australia, said that the study "will change clinical practice" and has "established a benchmark for subsequent trials that could assess new antibiotic combinations".

Edwin O. Ampadu, a researcher at Ghana's National Buruli Ulcer Control Programme and co-author of the study, told SciDev.Net that the research gives patients and clinicians hope that oral treatment can replace surgery when the disease is detected early.

"It is our hope that we can soon do away with surgery on Buruli ulcer. But there is the need to intensify early case detection in rural endemic communities, to enable antibiotic use," Ampadu said.

Kinsley Bampoe Asiedu, a Buruli ulcer expert at the WHO, said the study "takes us closer to our ultimate goal of getting a complete oral treatment for the disease. Ten years ago, it was inconceivable that treatment of Buruli ulcer with antibiotics was possible".

Link to abstract in The Lancet


The Lancet doi 10.1016/S0140-6736(09)61962-0 (2010)

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