Treating Buruli Ulcer: A Review of Prospects for Existing Antibiotics and New Therapeutics

Buruli ulcer disease is a serious necrotizing skin infection caused by the environmental pathogen Mycobacterium ulcerans and represents the third most common mycobacterial infection worldwide after tuberculosis and leprosy. This disease, if left untreated, can lead to disfiguring and disabling lesions, particularly affecting young populations in resource-poor settings.

Antibiotic treatment recommended by the World Health Organization (WHO) since 2004 has simplified the delivery of care for Buruli ulcer and provided solid evidence that early and limited lesions can be effectively treated with antibiotics alone. However the current recommendations still present significant challenges including the use of aminoglycosides requiring intramuscular injection. These drugs are difficult and costly to administer in resource-poor settings and have significant side effects that present major obstacles to implementation. 

Therefore, there is an urgent need to identify alternative oral regimens that can be effective, short-course, all-oral, compatible for use in pediatric population and have few drug-drug interactions with antiretrovirals (ARVs).