Buruli ulcer
ICD-10 A31.1 · ICD-11 1B21.20

Buruli Ulcer: What to Do When Initial Antibiotic Treatment Has Not Achieved Healing

When a rifampicin-based combination antibiotic regimen for Buruli ulcer does not achieve negative mycobacterial cultures and recurrence-free lesion healing, clinical management must progress to a structured next-line protocol. This page describes that specific situation.

Previous Treatment — Goals Not Met

The preceding regimen involved a rifampicin-based combination antibiotic course (rifampicin with streptomycin, clarithromycin, or moxifloxacin).

Escalation to this next-line protocol is indicated when that treatment fails to achieve:

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

Next-Line Approach

For extensive ulcers that have not responded adequately, this protocol involves a surgical approach aimed at hastening healing and achieving the best possible functional outcome — with specific guidance on when surgery is appropriate relative to antibiotic therapy.

Access the full structured protocol below for the complete intervention sequence and clinical decision pathway.

Instant Access to Structured Evidence-Based Regimens

References

  1. Debridement and skin grafting may be necessary to hasten healing of extensive ulcers.
  2. Small ulcers usually heal without surgical intervention, but larger wounds usually require debridement and skin grafting to hasten healing and to achieve the best possible functional result.
  3. A sound conservative approach is to allow 8 weeks of antibiotic treatment before surgical intervention.
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