Clinical Context

Buruli ulcer requires prompt antimicrobial treatment. This protocol defines the recommended first-line approach for confirmed or suspected cases, including when and how treatment should be administered under direct observation.

Treatment Approach

Management centres on a defined combination antibiotic regimen. The two agents are always given together throughout the course — combination use is critical to prevent selection of drug-resistant organisms. The protocol also specifies alternative oral regimens for circumstances in which the standard combination is not appropriate.

Complete agent selection, alternatives, and any restrictions by patient group are detailed in the full protocol.

Treatment Goals

Negative mycobacterial cultures from the lesion at 4, 8, and 12 weeks
Recurrence-free healing of the lesion

References

The two antibiotics should always be given in combination to prevent selection of drug-resistant mutants.
The patient should be treated with the recommended combination of rifampicin and streptomycin or rifampicin plus another oral therapy under direct observation for 8 weeks.
This guidance was based on the findings of a study of patients with small early lesions, which showed that, whereas mycobacteria were cultured from excised lesions 2 weeks after the start of antibiotic treatment, cultures were entirely negative at 4, 8 and 12 weeks (25).

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What is the treatment of Buruli ulcer? First-line antibiotic combination therapy

Clinical Context

Treatment Approach

Treatment Goals

References