Antibiotics currently play little part in the treatment of Buruli ulcer. Recommended drugs include rifampin, streptomycin and dapsone.

The WHO currently recommend rifampicin and streptomycin for eight weeks in the hope of reducing the need for surgery. The combination of rifampicin and clarithromycin has been used for many years in Australia. Rifampicin must never be used alone because the bacterium quickly becomes resistant^[1].

There are a number of experimental treatments currently being investigated:

• Sitafloxacin and rifampicin is a synergistic combination that only been trialled in mice.
• Rifalazil is a rifamycin antibiotic that appears to be more potent than rifampicin that has only been trialled in mice.
• Epiroprim and dapsone are synergistic when used in combination (in vitro studies only at present)
• Diarylquinoline shows high potency in vitro

In a small series of eight patients, local heat at 40°C led to complete healing without surgery (except the initial removal of dead tissue).^[2]

• Mycobacterium ulcerans ^[3]

• 1. Preulcerative lesions

• Excision and primary closure, Rifampin monotherapy, or heat therapy

• 2. Established ulcers

• Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice

• 3. Control complications of the ulcer

• Preferred regimen: Clarithromycin AND Rifampin