Meta-analysis comparing efficacy of antibiotics versus oral contraceptives in acne vulgaris

J Am Acad Dermatol. 2014 Sep;71(3):450-9. doi: 10.1016/j.jaad.2014.03.051. Epub 2014 May 28.

Abstract

Background: Both antibiotics and oral contraceptive pills (OCPs) have been found to be effective in managing acne vulgaris. Despite widespread use, few direct comparisons of efficacy between the 2 modalities have been published.

Objective: We compared the efficacy of antibiotics and OCPs in managing acne.

Methods: A meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane collaboration guidelines.

Results: A review of 226 publications yielded 32 randomized controlled trials that met our inclusion criteria. At 3 and 6 months, compared with placebo, both antibiotics and OCPs effected greater percent reduction in inflammatory, noninflammatory, and total lesions; the 2 modalities at each time point demonstrated statistical parity, except that antibiotics were superior to OCPs in percent reduction of total lesions at 3 months (weighted mean inflammatory lesion reduction: 3-month course of oral antibiotic treatment = 53.2%, 3-month course of OCPs = 35.6%, 3-month course of placebo treatment = 26.4%, 6-month course of oral antibiotic treatment = 57.9%, 6-month course of OCPs = 61.9%, 6-month course of placebo treatment = 34.2%; weighted mean noninflammatory lesion reduction: 3-month course of oral antibiotic treatment = 41.9%, 3-month course of OCPs = 32.6%, 3-month course of placebo treatment = 17.1%, 6-month course of oral antibiotic treatment = 56.4%, 6-month course of OCPs = 49.1%, 6-month course of placebo treatment = 23.4%; weighted mean total lesion reduction: 3-month course of oral antibiotic treatment = 48.0%, 3-month course of OCPs = 37.3%, 3-month course of placebo treatment = 24.5%, 6-month course of oral antibiotic treatment = 52.8%, 6-month course of OCPs = 55.0%, 6-month course of placebo treatment = 28.6%).

Limitations: Investigative treatment heterogeneity and publication bias are limitations.

Conclusions: Although antibiotics may be superior at 3 months, OCPs are equivalent to antibiotics at 6 months in reducing acne lesions and, thus, may be a better first-line alternative to systemic antibiotics for long-term acne management in women.

Keywords: acne vulgaris; birth control; meta-analysis; oral antibiotics; oral contraceptive; tetracyclines.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Acne Vulgaris / drug therapy*
  • Anti-Bacterial Agents / therapeutic use*
  • Contraceptives, Oral / therapeutic use*
  • Contraceptives, Oral, Combined / therapeutic use
  • Estradiol / administration & dosage
  • Female
  • Humans
  • Progestins / administration & dosage
  • Tetracyclines / therapeutic use
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Contraceptives, Oral
  • Contraceptives, Oral, Combined
  • Progestins
  • Tetracyclines
  • Estradiol