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


RESULTS
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.


CONCLUSIONS
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.
Ozolins
Mara
M
Centre of Evidence-based Dermatology, Queens Medical Centre, Nottingham, UK.
Eady
E Anne
EA
Avery
Anthony J
AJ
Cunliffe
William J
WJ
Po
Alain Li Wan
AL
O'Neill
Ciaran
C
Simpson
Nick B
NB
Walters
Christina E
CE
Carnegie
Ellen
E
Lewis
Jennifer B
JB
Dada
John
J
Haynes
Mary
M
Williams
Karen
K
Williams
Hywel C
HC
D000152:Acne Vulgaris / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001585:Benzoyl Peroxide / Q000008:administration & dosage; D002648:Child; D003362:Cost-Benefit Analysis; D004917:Erythromycin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D005148:Facial Dermatoses / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008911:Minocycline / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D010118:Oxytetracycline / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D016037:Single-Blind Method; D012867:Skin / Q000382:microbiology
D000900:Anti-Bacterial Agents; D004917:Erythromycin; D008911:Minocycline; D001585:Benzoyl Peroxide; D010118:Oxytetracycline