Although antibiotics have been used...

Although antibiotics have been used for decades to treat acne vulgaris, acne is not a traditional infection. Ozolins and colleagues bearinged a randomized controlled trial of five antibiotic regimens for acne vulgaris.

Patients were recruited from a British general practice research network. Criteria for inclusion in the thought were mild to moderate acne vulgaris with at least 15 inflamed and 15 noninflamed lesions in succession the face, no known hypersensitivity to investigation medications, and willingness to stop all acne therapy for four weeks before the close attention Patients with other forms of acne and those whose symptoms began after 26 years of age were exclud from the studious mood Other exclusions were previous therapy with oral isotretinoin (Accutane), existence of any serious systemic disease, use of any interacting medication, or participation in another clinical trial within the previous three months

The 649 participants were randomly assigned to the same of five antimicrobial regimens: (1) oral oxytetracycline (Terramycin) 500 mg twice daily and topical placebo cream twice daily; (2) oral minocycline (Minocin) 100 mg one time daily and topical placebo cream twice daily; (3) oral placebo one time daily and topical 5 percent benzoyl peroxide twice daily; (4) oral placebo daily and topical 5 percent benzoyl peroxide plus 3 percent erythromycin (Benzamycin) twice daily; and (5) oral placebo one time daily and topical 2 percent erythromycin (T-stat) in the morning and topical 5 percent benzoyl peroxide in the evening. All patients were provided with specific written instructions and nonmedicated soap and moisturizing cream for any local irritation. Adherence was monitored end diaries and return of unused medications. Patients were assessed at baseline and after six, 12 and 18 weeks of therapy. results monitored were primarily a patient self-assessment using a six-point Likert scale and scoring of acne severity by the agency of a trained research assistant. The acne severity score accounted for rednes inflamed lesions, and noninflamed lesions upon four areas of the face; and the severity and the number of lesions. Patients also reported quality of life using sum of two units standardized questionnaires. The study also monitored skin colonization through antibioticresistant propionibacteria.

The patients assigned to either treatment regimen were comparable in all significant variables. Overall, 27 percent of participants did not ended the study. All regimens showed greatest improvement within six weeks (see accompanying table). The sum of two units regimens containing topical erythromycin had the highest efficacy, if it be not that results were not statistically significant. These sum of two units regimens also showed the greatest reduction in propionibacterial activity. The regimen containing minocycline was in the greatest degree compromised by antibiotic resistance. Adverse reactions were noted by means of 28 percent of participants at week 6 if it were not that only 15 percent reported these by means of week 12. Systemic adverse tenors were most common in patients assigned oral antibiotics. The researchers assigned the greatest preciousness benefit to regimen 3, followed through regimens 5, 1, 4, and 2 in decreasing order. The costliness for 18 weeks of therapy ranged from $1034 to $18970

The authors deduce that the five regimens occasion similar results but have large differences in cost-effectiveness. Because in the greatest degree benefit occurs within six weeks, the authors propose limiting the duration of the antibiotics when they manifest ineffective after six weeks.

ANNE D WALLING, MD

Ozolins M et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controll trial. Lancet December 18-25 2004;364:2188-95

COPYRIGHT 2005 American Academy of Family Physicians

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