Buruli Ulcer in Pregnancy When First-Line Antibiotic Treatment Has Not Achieved Lesion Healing
This protocol applies to pregnant patients with Buruli ulcer whose first-line antibiotic regimen — rifampicin combined with clarithromycin — did not result in negative mycobacterial cultures or recurrence-free healing of the lesion. A defined next clinical step is indicated.
Previous treatment — failure condition
The preceding regimen (rifampicin + clarithromycin) targeted negative mycobacterial cultures from the lesion at 4, 8, and 12 weeks, and recurrence-free healing. When those targets are not met, escalation to the approach outlined here is warranted.
Next-step approach (partial overview)
The next step involves a surgical approach — centred on debridement — for extensive ulcers that have not responded adequately to antibiotics alone. The complete protocol specifies full indications, timing in relation to antibiotic therapy, and any additional steps required to achieve the best functional outcome.
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).
- Debridement and skin grafting may be necessary to hasten healing of extensive ulcers.
- 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.
- A sound conservative approach is to allow 8 weeks of antibiotic treatment before surgical intervention.
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