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Treatment failure, liver cirrhosis and paradoxical reaction: 7 case reports In a prospective observational cohort consisting of 430 patients who were treated with antibiotics from 1 January 1998 to 31 December 2018, seven males aged 1-86 years were described who exhibited treatment failure following treatment with rifampicin and clarithromycin for buruli ulcer secondary to Mycobacterium ulcerans infection. Out of these seven patients, one patient (patient 3) also developed liver cirrhosis and paradoxical reaction and three patients (patient 2, 5 and 7) developed paradoxical reaction during treatment with rifampicin and clarithromycin [time to reaction onsets not clearly stated; outcomes not stated]. Patient 1 from table 2 of the article: A 1-year-old boy, who had buruli ulcer secondary to Mycobacterium ulcerans infection, started receiving oral antibiotic therapy with rifampicin [rifampin] 10 mg/kg and clarithromycin 13.3 mg/kg. He received antibiotic therapy for total 56 days. However, 100 days after initiating antibiotic therapy, he experienced culture-positive relapse of buruli ulcer at initial site, indicating treatment failure. Patient 2 from table 2 of the article: A 62-year-old man, who had buruli ulcer secondary to Mycobacterium ulcerans infection, started receiving oral antibiotic therapy with rifampicin [rifampin] 4.4 mg/kg and clarithromycin 7.3 mg/kg. He received antibiotic therapy for total 56 days. However, 175 days after initiating antibiotic therapy, he experienced culture-positive relapse of buruli ulcer at initial site, indicating treatment failure. He also developed paradoxical reaction secondary to antibiotic regimen. Patient 3 from table 2 of the article: An 86-year-old man, who had buruli ulcer secondary to Mycobacterium ulcerans infection, started receiving oral antibiotic therapy with rifampicin [rifampin] 3.0 mg/kg and clarithromycin 5.1 mg/kg. He was also receiving unspecified corticosteroids. Subsequently, he developed liver cirrhosis suspected to be secondary to antibiotic therapy. Therefore, his antibiotic regimen dose was decreased to rifampicin 300mg daily and clarithromycin 250mg twice daily. He received antibiotic therapy for total 84 days. However, 252 days after initiating antibiotic therapy, he experienced culture-positive relapse of buruli ulcer at initial site, indicating treatment failure. He also developed paradoxical reaction secondary to antibiotic regimen. Patient 4 from table 2 of the article: A 79-year-old man, who had buruli ulcer secondary to Mycobacterium ulcerans infection, started receiving oral antibiotic therapy with rifampicin [rifampin] 5.9 mg/kg and clarithromycin 4.9 mg/kg. Laboratory investigation revealed low estimated glomerular filtration rate [aetiology not stated]. Clarithromycin dose was reduced to 250mg twice daily. He received antibiotic therapy for total 56 days. However, 175 days after initiating antibiotic therapy, he experienced culture-positive relapse of buruli ulcer as a local new lesion, indicating treatment failure. Patient 5 from table