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Strategy of acne therapy with oral antibiotics
Author(s) -
Hughes Bronwyn R.,
Cunliffe W.J.
Publication year - 1987
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1987.tb12015.x
Subject(s) - acne , minocycline , benzoyl peroxide , erythromycin , medicine , antibiotics , gastroenterology , surgery , dermatology , polymer , chemistry , organic chemistry , microbiology and biotechnology , polymerization , biology
Oral antibiotics remain the conventional treatment for clinical acne. Greenwood et al. 1 showed that on 0·5 g/day of erythromycin certain sub‐groups of patients did less well and that 1·0 g/day gave significantly better results. Our aim in this investigation was to assess whether using this higher dose, the risk factors had been eliminated, and to as certain effects of even longer courses of oral treatment. 502 patients (mean age 19 years) were treated with erythromycin 1·0 g daily and topical benzoyl peroxide. The overall improvement of the acne grade after 6 months of treatment was 67·8%. In contrast to lower doses (0·5 g/day), neither age at presentation, duration, severity, nor site of acne was found to affect the therapeutic response to 1·0 g/day. However, male patients did significantly worse than female ( P < 0· 01). After 6 months of treatment patients were continued on one of two options for a further 6 months: benzoyl peroxide alone, or erythromycin 1·0 g/day, plus benzoyl peroxide. Patients in Group 2 did not improve significantly during the second 6 months of therapy nor were they improved compared to Group 1. We also investigated 60 patients whose treatment had failed (< 50% improvement) at 6 months. Half were treated with erythromycin (1 g/day) and half with minocycline (100 mg b.d.), Both these groups improved after a second 6 months of therapy but those on minocycline did significantly better ( P <0·05), Side‐effects on all regimes were minimal. We conclude that with the now recommended dose schedule of 1 g/day all risk factors with the exception of the patients'sex are eliminated, and that if after 6 months therapy there is a successful outcome, there is no justification in continuing oral therapy. Some patients (11·9%) ‘fail’; many of these patients are slow responders and continuation of therapy with either the same or preferably a change of antibiotics is justified.