Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial

Lancet. 2004 Dec 18-31;364(9452):2188-95. doi: 10.1016/S0140-6736(04)17591-0.

Abstract

Background: We investigated the efficacy and cost-effectiveness of five antimicrobial regimens for mild to moderate facial acne and whether propionibacterial antibiotic resistance affects treatment response.

Methods: In this randomised, observer-masked trial, 649 community participants were allocated one of five antibacterial regimens. Primary outcomes were patients' self-assessed improvement and reduction in inflamed lesions at 18 weeks. Analyses were by intention to treat.

Findings: Moderate or greater improvement at 18 weeks was reported in 72 (55%) of 131 participants assigned oral oxytetracycline plus topical placebo, 70 (54%) of 130 assigned oral minocycline plus topical placebo, 78 (60%) of 130 assigned topical benzoyl peroxide plus oral placebo, 84 (66%) of 127 assigned topical erythromycin and benzoyl peroxide in a combined formulation plus oral placebo, and 82 (63%) of 131 assigned topical erythromycin and benzoyl peroxide separately plus oral placebo. Most improvement occurred in the first 6 weeks. Treatment differences for the proportion of people with at least moderate improvement were: minocycline versus oxytetracycline -1.2% (unadjusted 95% CI -13.3 to 10.9); combined erythromycin and benzoyl peroxide versus oxytetracycline 11.1% (-0.7 to 22.9) and versus minocycline 12.3% (0.4 to 24.2); erythromycin and benzoyl peroxide separately versus combined formulation -3.5% (-15.2 to 8.2); benzoyl peroxide versus oxytetracycline 5.0% (-7.0 to 17.0), versus minocycline 6.2% (-5.8 to 18.2), and versus combined formulation -6.1% (-17.9 to 5.7). Benzoyl peroxide was the most cost-effective treatment. Efficacy of both tetracyclines was reduced by pre-existing tetracycline resistance.

Interpretation: Topical benzoyl peroxide and benzoyl peroxide/erythromycin combinations are similar in efficacy to oral oxytetracycline and minocycline and are not affected by propionibacterial antibiotic resistance.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acne Vulgaris / drug therapy*
  • Acne Vulgaris / economics
  • Acne Vulgaris / microbiology
  • Administration, Oral
  • Administration, Topical
  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / economics
  • Benzoyl Peroxide / administration & dosage
  • Child
  • Cost-Benefit Analysis
  • Erythromycin / administration & dosage
  • Erythromycin / adverse effects
  • Erythromycin / economics
  • Facial Dermatoses / drug therapy*
  • Facial Dermatoses / microbiology
  • Female
  • Humans
  • Male
  • Minocycline / administration & dosage
  • Minocycline / adverse effects
  • Minocycline / economics
  • Oxytetracycline / administration & dosage
  • Oxytetracycline / adverse effects
  • Oxytetracycline / economics
  • Single-Blind Method
  • Skin / microbiology

Substances

  • Anti-Bacterial Agents
  • Erythromycin
  • Minocycline
  • Benzoyl Peroxide
  • Oxytetracycline