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ORIGINAL ARTICLE
Year : 2006  |  Volume : 51  |  Issue : 4  |  Page : 255-257
Comparison of three different regimens of oral azithromycin in the treatment of acne vulgaris


Department of Dermatology, Isfahan Medical University, Iran

Correspondence Address:
Farahnaz Fatemi Naieni
Department of Dermatology, Isfahan Medical University, PO.box 905, Alzahra hospital, Isfahan
Iran
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DOI: 10.4103/0019-5154.30288

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   Abstract 

Background: Acne vulgaris is a common skin disease that involves pilosebaceous units. Oral antibiotics are the most widely administered drugs, which are prescribed as systemic therapy for treatment of moderate to severe acne vulgaris. Azithromycin is one of the antibiotics that has been recently used for acne treatment. There are several protocols of oral azithromycin in the treatment of acne. Objective: To compare three various regimens of oral azithromycin in the treatment of acne. Materials and Methods: Sixty-four patients with moderate to severe acne were divided into three groups randomly. First group (21 patients) received azithromycin as follow: five consecutive days, 500 mg on the first day and 250 mg daily for a further four days per month. Second group (22 patients): 500 mg daily for four consecutive days per month and the last group (21 patients): 250 mg daily thrice weekly. After the baseline visit, patients were scheduled to return at four-weekly intervals among 12 weeks. Result: There were no differences between three groups in decreasing of acne grading score. ( P >0.05). Efficacy of minimal dose was equal to maximum dose of azithromycin in treatment of acne. Oral azithromycin in all groups resulted in a significant decrease in acne grading score in each consecutive visit ( P <0.001). Conclusion: Because of expensiveness of azithromycin,, we recommend azithromycin in low dose (1500 mg monthly) which is as effective as a high dose (3000 mg monthly) with lower cost, has more compliance and fewer side-effects.


Keywords: Acne vulgaris, azithromycin


How to cite this article:
Naieni FF, Akrami H. Comparison of three different regimens of oral azithromycin in the treatment of acne vulgaris. Indian J Dermatol 2006;51:255-7

How to cite this URL:
Naieni FF, Akrami H. Comparison of three different regimens of oral azithromycin in the treatment of acne vulgaris. Indian J Dermatol [serial online] 2006 [cited 2014 Oct 24];51:255-7. Available from: http://www.e-ijd.org/text.asp?2006/51/4/255/30288



   Introduction Top


Acne vulgaris is a chronic inflammatory skin disease that involves pilosebaceous units.

Early effective treatment of acne lesions is very important to prevent facial scars that lead to cosmetic and psychological impact to the patients.

Many systemic treatments used for acne vulgaris such as antibiotics, hormonal therapy, isotretinoin and occasionally, corticosteroids.[1]

Azithromycin is one of the antibiotics that has been recently prescribe for treatment of acne which is at least as effective as doxycycline and minocycline.[2],[3],[4],[5]

Aziythromycin is a nitrogen-containing macrolide antibacterial agent and a methyl derivative of erythromycin with actions and uses similar to those of erythromycin.[6],[7] Its extensive distribution in the tissues allows pulse-dose regimen recommendation for increased compliance.[8]

The current adult dose of azithromycin is 500 mg daily for three days or alternatively, 500 mg as initial dose followed by 250 mg daily for a further four days.[6],[7] There are several protocols of oral azithromycin for acne treatment. In this randomized, investigator-blinded study we compared the efficacies of three various regimens of oral azithromycin in acne treatment. The main outcome measure was global acne score in each session and comparison of this score in simultaneous sessions between groups.[9] We conducted this study to compare the efficacy of three protocols of oral azithromycin in treatment of acne to select a cost-effective protocol.


   Materials and Methods Top


Sixty-four patients (56 women, 8 men) between 14 and 38 years and with moderate to sever acne (score of acne 19-38), in the Global Acne Grading System (GAGS), were included in the study.[9]

Every patient was being exact physical examination and graded by GAGS.

In GAGS, acne patients were assigned into four grades. Mild = 1-18 score, moderate = 19-30 score, severe = 31-38 score, very severe >39 score (9).

In this study patients were excluded if:

  1. Global acne score was greater than 39 or lower than 19.
  2. Concomitant use of anti-androgenic drugs
  3. Isotretinoin use in the last six months


Participants were awarded and investigators got written informed consent from them. After that, they were allocated to three groups with simple randomization method by usage of random number table.

We prescribed azithromycin in these groups as follow:

First group: 500 mg azithromycin as initial dose followed by 250 mg daily for further four days per month.

Second group: 500 mg daily for four consecutive days per month and

Third group: 250 mg daily thrice weekly.

We followed patients over a 12-week period and visited them monthly.

At each visit, acne lesions were assessed by blinded dermatologist to treatment protocols and GAGS was used to evaluate the response of patients to treatment.

The patient visits were done at the end of first, second and third month.

The efficacy of each protocol was investigated by comparing the decrease of acne score at each visit, with the baseline and previous session grade. We then compared protocols' efficacies between three groups.

Descriptive statistical methods multivariate repeated measure ANOVA with Hotelling's trace test for between groups comparison.

All analyses were undertaken using SPSS version 11.5 for Windows (SPSS Inc, Chicago. Ill.) and P values were two-tailed and statistical significance was defined as P <0.05. Multivariate repeated measure of Anova with Hotelling's Trace Test was carried out for repeated comparison between trail groups.

Our study was approved by the research ethical committee of Isfahan Medical Science University.


   Results Top


Twenty patients in the first group, 19 patients in the second group and 19 patients in the third group completed the treatment and the follow-up period.

There were no differences between three groups in decreasing of acne grading score. ( P >0.05) [Table - 1] [Figure - 1].

No significant statistical differences were seen between groups in mean age and acne score and sexes of individuals. [Table - 2] shows the characteristics of participants.

The mean acne scores did not differ meaningfully between the study groups at repeated evaluations during the three month assessment.

However, the mean acne score had significantly decreased at the end of first, second and third month after treatment when compared to baseline. P < 0.001 [Table - 2] [Figure - 1].

Diarrhea was the only complication which occurred in three patients of third group.


   Discussion Top


We conducted this study to compare the efficacy of three protocols of oral azithromycin in treatment of acne over a 12-week period to select a cost-effective protocol of oral azithromycin for acne treatment.

Many systemic treatments are used for acne vulgaris such as antibiotics, hormone therapy, isotretinoin and occasionally, corticosteroids.[1]

Oral antibiotics is the most widely practiced systemic treatment administered for acne. Azithromycin is one of the antibiotics that has been recently prescribed for treatment of acne and is at least as effective as doxycycline and minocycline.[2],[3],[4],[5]

Aziythromycin is a nitrogen-containing macrolide, antibacterial agent and a methyl derivative of erythromycin with actions and uses similar to those of erythromycin.[6],[7] Its extensive distribution in the tissues allows pulse dose regimen recommendation for increased compliance.[8]

Azithromycin was known as a broad spectrum antibiotic with activity against Gram-positive (streptococci and staphylococci) and some Gram-negative pathogens such as Haemophilus influenzae and  Moraxella More Details catarrhalis. It is also active against some of entrobacteriaceae such as Escherchia coli and  Salmonella More Details and Shigella spp. azithromycin is also active against Chlamydia trachomatis and Mycobacterium avium complex.[10],[11],[12]

At first, Fernandez-Obregon reported azithromycin for treatment of acne vulgaris.[2]

There is no doubt that azithromycin is an effective antibiotic in treatment of acne vulgaris.[3],[4],[13],[14]

There are several regimens of oral azithromycin in acne treatment.

In the treatment of acne vulgaris, Kapida et al . prescribed it - 500 mg orally thrice weekly[13] whereas the recommended dose of Parsad et al . was 500 mg once a day for four days per month[14] and Fernandez-Obregon used it as 250 mg orally three times a week.[3] All of them followed patients over a 12-week period.

We recommended it as current adult dose: 500 mg initial dose and 250 mg daily for a further four days per month for 12 weeks and compared it to protocols of Parsad et al . and Fernandez-Obregon.

In current adult dose, patients received 1500 mg azithromycin monthly. In Parsad's protocol they received 2000 mg monthly and in the Fernandez-Obregon's protocol they received 3000 mg monthly.

The results of this study showed that all of the three protocols were effective in treatment of acne lesions and there were no significant difference between their efficacies.

The only complication was diarrhea which occurred in three patients of the third group, may be due to higher dose. Two patients were successfully treated with magnesium trisilicate and one of them discontinued treatment.

On the basis of this study we recommend oral azithromycin in low dose (1500 mg monthly) as effective as high dose (3000 mg monthly) with lower cost, more compliance and fewer side-effects.

 
   References Top

1.Stern RS. Acne therapy. Medication use and sources of care in office-based practice. Arc Dermatol 1996;132:776-80.   Back to cited text no. 1      
2.Fernandez-Obregon AC. Azithromycin for the treatment of acne. Int J Dermatol 1997;36:239-40.  Back to cited text no. 2  [PUBMED]    
3.Fernandez-Obregon AC. Azithromycin for the treatment of acne. Int J Dermatol 2000;39:45-50.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Kus S, Yucelten D, Aytug A. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of acne vulgaris. Clin Exp Dermatol 2005;30:215-20.  Back to cited text no. 4      
5.Gruber F, Grubisic-Greblo H, Kastelan M, Brajac I, Lenkovic M, Zamolo G. Azithromycin compared with minocycline in the treatment of acne comedonica and papulo-pustulosa. J Chemother 1998;10:469-73.  Back to cited text no. 5  [PUBMED]    
6.Peters DH, Friedel HA, McTavish D. Azithromycin. A review of its antimicrobial activity, pharmacokinetic properties and clinical efficacy. Drug 1992;44:750-99.  Back to cited text no. 6      
7.Alvrez-Elroco S, Enzler MJ. The macrolides. Erythromycin, clarithromycin and azithromycin. Mayo Clin Proc 1999;74:613-34.  Back to cited text no. 7      
8.Lalak NJ, Morris DL. Azithromycin clinical pharmacokinetics. Clin Pharmacokinet 1993;25:370-4.  Back to cited text no. 8  [PUBMED]    
9.Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading system and proposal of novel system. Int J Dermatol 1997;36:416-8.  Back to cited text no. 9  [PUBMED]    
10.Hamilton-Miller JM. In vitro activities of 14-, 15- and 16- membered macrolides against Gram-positive cocci. J Antimicrob Chemother 1992;29:141-7.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Gordillo ME, Singh KV, Murray BE. In vitro activity of azithromycin against bacterial enteric pathogens. Antimicrob Agents Chemother 1993;37:1203-5.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]  
12.Agacfidan A, Moncada J, Schachter J. In vitro activity of azithromycin against Chlamydia trachomatis and Chlamydia pneumoniae. Antimicrob Agents Chemother 1993;37:1746-8.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]  
13.Kapida N, Talib A. acne treated successfully with azithromycin. Int J Dermatol 2004;43:766-7.  Back to cited text no. 13      
14.Parsad D, Pandhi R, Nagpal R, Negi KS. Azithromycin monthly pulse vs. daily doxycycline in the treatment of acne vulgaris. J Dermatol 2001;28:1-4.  Back to cited text no. 14      


    Figures

  [Figure - 1]
 
 
    Tables

  [Table - 1], [Table - 2]

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