Treatment of Buruli Ulcer in Pregnancy
Buruli ulcer presenting in a pregnant patient requires careful selection of antibiotic therapy. The standard regimen for this infection includes an agent that is contraindicated during pregnancy, making an alternative combination necessary.
Clinical Scenario
This protocol applies specifically to pregnant patients with Buruli ulcer. Pregnancy excludes certain antibiotics that are otherwise part of the standard regimen. Published evidence includes a documented case of successful treatment in a pregnant patient using a rifampicin-based antibiotic combination.
Treatment Approach
Management is based on expert opinion and uses an oral antibiotic combination selected for compatibility with pregnancy. The complete regimen — including which agents are used, the course length, and any alternative formulation considerations — is detailed in the full protocol.
Treatment Goals
Success is defined by negative mycobacterial cultures from the lesion and recurrence-free healing of the wound.
References
- Rifampicin at 10 mg/kg body weight by mouth daily for 8 weeks and streptomycin at 15 mg/kg body weight by intramuscular injection daily for 8 weeks (contraindicated in pregnancy).
- A pregnant patient in Benin was successfully treated with a combination of rifampicin and clarithromycin (34).
- The recommendation, based on expert opinion, is therefore: rifampicin at 10 mg/kg body weight by mouth daily for 8 weeks and clarithromycin at 7.5 mg/kg body weight by mouth twice daily for 8 weeks.
- The extended-release formulation of clarithromycin may be used at 15 mg/kg body weight once daily, although it has yet to be tested.
- 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).