title: Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial.
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.
  
  
  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.
authors.affiliation: Centre of Evidence-based Dermatology, Queens Medical Centre, Nottingham, UK.
authors.forename: Mara
authors.initials: M
authors.lastname: Ozolins
authors.forename: E Anne
authors.initials: EA
authors.lastname: Eady
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Avery
authors.forename: William J
authors.initials: WJ
authors.lastname: Cunliffe
authors.forename: Alain Li Wan
authors.initials: AL
authors.lastname: Po
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.forename: Nick B
authors.initials: NB
authors.lastname: Simpson
authors.forename: Christina E
authors.initials: CE
authors.lastname: Walters
authors.forename: Ellen
authors.initials: E
authors.lastname: Carnegie
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Lewis
authors.forename: John
authors.initials: J
authors.lastname: Dada
authors.forename: Mary
authors.initials: M
authors.lastname: Haynes
authors.forename: Karen
authors.initials: K
authors.lastname: Williams
authors.forename: Hywel C
authors.initials: HC
authors.lastname: Williams
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin; D008911:Minocycline; D001585:Benzoyl Peroxide; D010118:Oxytetracycline