Clinical efficacy of Rifampicin and Streptomycin in combination against Mycobacterium ulcerans infection: a systematic review

Abstract

Buruli ulcer (BU) is a cutaneous neglected tropical disease caused by Mycobacterium ulcerans. Synthesizing the evidence on their efficacy of antibiotic in the management of BU can help to better define their roles, identify weaknesses and inform clinicians on relevant measures than can be used to control BU. Our objectives is to assess the clinical efficacy of Rifampicin-Streptomycin given for 8 weeks of treatment of early M. ulcerans infection. We searched the following electronic databases from January 2005 to July 2012: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions to language or publication status. All study designs that could provide the information we sought for were eligible provided the studies were conducted in the third world. Critical appraisal of all identified citations was done independently by three authors to establish the possible relevance of the articles for inclusion in the review. Of the 115 studies, 09 papers met the inclusion criteria. The duration of treatment ranged from 8 to 48 weeks depending on the severity. Oral chemotherapy alone obtained a curative rate of 50%. The “dual” mode of treatment (surgery + chemotherapy) reduced hospital admission period from 90 to 39.8 days, that's to 44.2%. This treatment for early stages could therefore replace surgery and in severe cases, is an indispensable aid before surgery. These results confirmed that the daily administration of Rifampicin and Streptomycin is an effective treatment for M. ulcerans infection in an early stage. Subsequent systematic reviews should be conducted to determine if antibiotics could heal injuries without resorting to surgery and to compare different treatment durations.

Buruli Ulcer: Review of a Neglected Skin Mycobacterial Disease

“…Medical treatment using daily oral rifampin and intramuscular streptomycin for 8 weeks was introduced in the early 2000s (22) and is recommended by the WHO (1). A review of treatment studies performed in eight African countries and one in Australia showed that this regimen achieved on average a 50% cure rate (30). This antibiotic regimen is highly effective for lesions that are less than 10 cm in diameter, as these patients may not require surgery.…”

Exploration of a standard treatment for Buruli ulcer through a comprehensive analysis of all cases diagnosed in Japan

“…11 Other investigators have also reported that oral antimicrobial therapy alone is not effective in treating BU, and surgical intervention was required in other studies. 4,7,9,12 Thus, although oral antimicrobial therapy has emerged as an attractive alternative to surgery for BU treatment, the regimen, administration, duration and efficacy of the optimal treatment remain undefined. To date, there are no published studies on the efficacies of BU treatments in Asian countries, possibly because of the much lower occurrence of reported BU cases than in endemic countries.…”

“…Of the 122 patients, 90 were clinically cured, but 21 were referred for surgery (eight patients refused surgery and three dropped out) . Other investigators have also reported that oral antimicrobial therapy alone is not effective in treating BU, and surgical intervention was required in other studies …”

Drugs for treating Buruli ulcer (Mycobacterium ulcerans disease)

“…No systematic review of the literature on Buruli ulcer has previously been performed. A review of the efficacy of daily administration of rifampicin and streptomycin in the treatment of early‐stage Buruli ulcer including data from 2005 to 2012 was published in 2013 (Vouking 2013). In that review, evidence of diagnostic accuracy and ascertainment of cure was not clear.…”