Oral antibiotics might treat Buruli ulcer

It might be possible to treat Buruli ulcer, a crippling and deforming disease, with only oral medicines, which would make treatment easier. And even the current treatment can in many cases be given in an outpatient regimen. Which means it can be given in decentralised medical outposts. Local health workers reach many more people than a central hospital, so more cases can be early diagnosed, when treatment still is easy. So control programs for this neglected disease should run decentralised. This is one of the conclusions of research in Benin, which was rewarded with a doctorate at the Antwerp Institute of Tropical Medicine and the University of Antwerp.

Buruli ulcer (BU) is caused by a mycobacterium (as are tuberculosis and leprosy). Mycobacterium ulcerans causes skin lesions, that can grow to crippling holes and even affect the bone. If detected early, the lesion can be excised with minor surgery, or stopped with antibiotics. It mostly occurs in poor tropical and subtropical regions, so there is no financial incentive for the pharma industry to develop new treatments.

During the last decade, great advances have been made in the control of Buruli ulcer since endemic countries created a BU control program. Since 2005 Benin uses the combination therapy with streptomycin and rifampin that was recommended by the World Health Organisation the year before. Dr. Ghislain Sopoh, chief physician of the the BU treatment center (CDTUB) of Allada, in Benin, compared a series of BU patients to 'healthy' persons from the same village, matched for age and sex, to pinpoint possible risk factors for developing the disease. It became clear that a combination of environmental (altitude), genetic and behavioural factors may increase the risk for developing BU. These findings are currently used for more efficient BU control activities.

His epidemiological studies demonstrated the validity of the surveillance system of Benin and showed the focal distribution of the disease. The treatment with antibiotics and surgery as needed, works well. Patients with early-stage lesions don't have to be hospitalised, and can be treated as outpatients. Which means the (first line) treatment can be delegated to local health workers, who reach a lot of people.  

Sopoh's research also helped in making therapeutic decisions on when to apply a surgical intervention. However, the management of late reported cases remains a great problem for BU treatment centers, as well as the paradoxical reactions and disseminations seen in some late cases, mainly osteomyelitis.

Further research is needed, but it seems BU can be treated fully with oral antibiotics. At least, this approach worked well with a pregnant woman, where physicians were obliged to replace the streptomycin (contra-indicated during pregnancy) with oral clarithromycin.