Buruli ulcer

Role of specific antibiotics in Mycobacterium ulcerans (Buruli ulcer) management

Provisional guidelines

Implementation of this guidance

  • Close collaboration with TB programmes at all levels is recommended, particularly in areas such as coordination of drug procurement, use of TB laboratory facilities and networks, and monitoring for potential antibiotic resistance.
  • Before implementation of this guidance, national control programmes should organize workshops to train health workers on the correct and consistent use of the guidance.
  • The initial implementation of this guidance should be in endemic areas where the disease may be reliably diagnosed and where treatment in accordance with the guidance should be possible. To avoid or minimize wasteful treatment of patients who do not have M. ulcerans disease, at least a strong clinical diagnosis is essential before antibiotic treatment is started.
  • National control programmes should ensure that the health facilities where this guidance is implemented have the following: (i) continuous uninterrupted supply of the antibiotics; (ii) the necessary recording forms (Annexes 2–4); (iii) a camera (preferably digital); and (iv) specimen containers (containing transport media for microbiological analyses and 10% formalin for histopathology analysis) for collection and timely transport of specimens to designated local laboratories or reference laboratories abroad.
  • National control programmes should develop simple patient treatment cards and health facility registers to support the implementation of this guidance. Examples that may be adapted to suit the needs of particular programmes are given in Annexes 2, 3 and 4.
  • To reduce the pressure on limited numbers of hospital beds, patients with small early lesions not needing hospitalization and those with larger lesions who are well enough to take antibiotics at home while awaiting definitive surgery may be given a 2-week course of antibiotics under direct observation in a health-care facility close to their homes. After the 2 weeks, patients should return to the hospital for reassessment: provided that there is evidence of improvement, the antibiotics should be given for a further 2 weeks. This regimen should continue until the patient has completed the course of antibiotic treatment or is ready for surgery. It should be understood that compliance with the prescribed treatment (e.g. the regular daily oral intake of rifampicin at the standard dose and sterile intramuscular injections of the standard dose of streptomycin) is crucial.
  • If the patient is not hospitalized, it is important to ensure the appropriate dressing of ulcers.
  • All patients treated with antibiotics should be registered and the following information should be recorded: name, age, sex, address (city/town/village), date treatment started, date treatment ended, measurements of response to treatment (including reduction of swelling around the lesion), adverse effects and whether or not surgery was performed (see Annex 3).