title: Meta-analysis comparing efficacy of antibiotics versus oral contraceptives in acne vulgaris.
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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Eubee Baughn
authors.initials: EB
authors.lastname: Koo
authors.affiliation: Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Lebanon, Oregon.
authors.forename: Tyler Daniel
authors.initials: TD
authors.lastname: Petersen
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: harvardskinstudies@partners.org.
authors.forename: Alexandra Boer
authors.initials: AB
authors.lastname: Kimball
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003276:Contraceptives, Oral / Q000627:therapeutic use*; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D004958:Estradiol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D011372:Progestins / Q000008:administration & dosage; D013754:Tetracyclines / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003276:Contraceptives, Oral; D003277:Contraceptives, Oral, Combined; D011372:Progestins; D013754:Tetracyclines; D004958:Estradiol
keywords: acne vulgaris; birth control; meta-analysis; oral antibiotics; oral contraceptive; tetracyclines