Dr Mark Wansbrough-Jones has led a series of clinical studies showing that antibiotics are highly effective treatments for Buruli ulcer.
Infections with Mycobacterium ulcerans cause disfiguring skin lesions, known as Buruli ulcer. The condition is common in parts of West Africa, mainly affecting children aged 5–15. Until recently, the main treatment was surgical excision, which is difficult to perform, not always successful and not accessible to people in remote locations.
Following positive studies in animal models, Dr Wansbrough-Jones with colleagues including Professor Richard Phillips organised a clinical study in Ghana evaluating a combination of antibiotics – rifampicin and streptomycin – given for various periods before clinical excision. Eight weeks’ treatment was highly effective at killing M. ulcerans and preventing disease recurrence.
A larger follow-on study in Ghana confirmed the efficacy of antibiotic therapy, even in the absence of surgery. As streptomycin has to be injected into muscle, an oral drug, clarithromycin, has also been used instead of streptomycin for part or all of the eight-week treatment. The latest study, in Ghana and Benin and reported to the WHO in 2017, confirmed the efficacy of an all-oral combination.
These findings have shaped WHO guidelines on treatment of Buruli ulcer, which are likely to be updated in light of the latest findings.
Etuaful S et al. Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of Buruli ulcer in humans. Antimicrob Agents Chemother. 2005;49(8):3182–6.
Sarfo FS et al. Clinical efficacy of combination of rifampin and streptomycin for treatment of Mycobacterium ulcerans disease. Antimicrob Agents Chemother. 2010;54(9):3678–85.
Phillips RO et al. Clinical and bacteriological efficacy of rifampin-streptomycin combination for two weeks followed by rifampin and clarithromycin for six weeks for treatment of Mycobacterium ulcerans disease. Antimicrob Agents Chemother. 2014;58(2):1161–6.