Looks like the pilz spammers have finally ditched the letters+numbers format.  
I'm now using this rule:

body    __MED_OB        
/\bw{2,3}(?:[[:punct:][:space:]]{1,5}|[[:space:][:punct:]]{1,3}dot[[:space:][:punct:]]{1,3})[[:alnum:]]{2,10}(?:[[:punct:][:space:]]{1,5}|[[:space:][:punct:]]{1,3}dot[[:space:][:punct:]]{1,3})(?:c\s?o\s?m|n\s?e\s?t|o\s?r\s?g)[[:punct:]]?\b/i
body    __MED_NOT_OB    /\bw{2,3}\.[[:alnum:]]{2,10}\.(?:com|net|org)\b/i
meta    AE_MED47        (__MED_OB && ! __MED_NOT_OB)
describe        AE_MED47        Shorter rule to catch spam obfuscation
score   AE_MED47        4.0

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