Towards Rational Use of Antibiotics for Suspected Secondary Infections in Buruli Ulcer Patients.

Background: The emerging disease Buruli ulcer is treated with streptomycin and rifampicin and surgery if necessary. Frequently other antibiotics are used during treatment. Methods/Principal Findings: Information on prescribing behavior of antibiotics for suspected secondary infections and for prophylactic use was collected retrospectively. Of 185 patients that started treatment for Buruli ulcer in different centers in Ghana and Bénin 51 were admitted. Forty of these 51 admitted patients (78%) received at least one course of antibiotics other than streptomycin and rifampicin during their hospital stay. The median number (IQR) of antibiotic courses for admitted patients was 2 (1, 5). Only twelve patients received antibiotics for a suspected secondary infection, all other courses were prescribed as prophylaxis of secondary infections extended till 10 days on average after excision, debridement or skin grafting. Antibiotic regimens varied considerably per indication. In another group of BU patients in two centers in Bénin , superficial wound cultures were performed. These cultures from superficial swabs represented bacteria to be expected from a chronic wound, but 13 of the 34 (38%) S. aureus were MRSA. Conclusions/Significance: A guide for rational antibiotic treatment for suspected secondary infections or prophylaxis is needed. Adherence to the guideline proposed in this article may reduce and tailor antibiotic use other than streptomycin and rifampicin in Buruli ulcer patients. It may save costs, reduce toxicity and limit development of further antimicrobial resistance. This topic should be included in general protocols on the management of Buruli ulcer. Author Summary: Buruli ulcer (BU) is a neglected, emerging disease caused by Mycobacterium ulcerans. BU usually starts as a nodule, papule, plaque, or oedema. When left alone, the lesion breaks open and a typical painless ulcer with undermined edges appears which can progress to a large necrotic lesion. BU is treated with antibiotics (streptomycin and rifampicin) and surgery if necessary. Apart from these two antibiotics, patients frequently receive other antibiotics during treatment. In files from patients treated in Benin and Ghana we found that in admitted patients a median of two antibiotic courses were prescribed. Only twelve patients received antibiotics for a suspected secondary infection, all other courses were prescribed as prophylaxis of secondary infection extended till 10 days on average after excision, debridement or skin grafting. In another patient group in Benin, superficial wound swabs from Buruli ulcers were performed and showed a high rate of MRSA. We propose a guideline for rational antibiotic treatment for suspected secondary infections or prophylaxis. Adherence to the proposed guideline will have a major impact on antibiotic use other than streptomycin and rifampicin in Buruli ulcer patients, saving costs, toxicity and development of antimicrobial resistance. [ABSTRACT FROM AUTHOR]