Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of buruli ulcer in humans
Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of buruli ulcer in humans
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DOI：
10.1128/aac.49.8.3182-3186.2005
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发表时间：
2005-08-01
影响因子：
4.9
通讯作者：
Wansbrough-Jones, A
中科院分区：
文献类型：
--
作者：
Etuaful, S;Carbonnelle, B;Wansbrough-Jones, A
溃疡分枝杆菌病在一些潮湿的热带地区很常见，特别是在西非部分地区，目前的治疗方法是手术切除从早期结节到广泛溃疡（布鲁里溃疡）的皮肤病变。布鲁里溃疡流行地区的患者将更容易获得抗生素治疗。我们报告了一项抗生素在将早期病变（结节和斑块）从培养阳性转化为培养阴性中的疗效研究。立即切除病变，或在每日口服利福平（10 mg/kg体重）和肌肉注射链霉素（15 mg/kg体重）治疗2、4、8或12周后切除病变，并通过定量细菌培养、PCR和组织病理学检查溃疡分枝杆菌。在治疗过程中测量病变。5个未使用抗生素治疗切除的病灶和5个使用抗生素治疗2周的病灶培养阳性，而3个治疗4周，5个治疗8周，3个治疗12周的病灶培养阴性。在抗生素治疗期间没有病变扩大，而且大多数病变变小。用利福平和链霉素治疗4周或更长时间可抑制人体组织中溃疡分枝杆菌的生长，这为进行早期溃疡分枝杆菌疾病的抗生素治疗替代手术的试验提供了基础。
Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and three treated for 12 weeks were culture negative. No lesions became enlarged during antibiotic treatment, and most became smaller. Treatment with rifampin and streptomycin for 4 weeks or more inhibited growth of M. ulcerans in human tissue, and it provides a basis for proceeding to a trial of antibiotic therapy as an alternative to surgery for early M. ulcerans disease.