Facial acne is common among adolescents; antibiotic tablet treatment has been used extensively over the past 40 years. Concerns exist about increasing antibiotic resistance, and few studies have compared the efficacy and cost-effectiveness of different treatment options for acne--including the comparison of tablet antibiotics and antibiotic lotions with the antimicrobial treatment benzoyl peroxide.
Hywel Williams and colleagues from the Universities of Nottingham and Leeds, UK, compared 5 treatment options for acne in a randomised trial involving around 650 participants. The treatments being compared were: the oral antibiotics oxytetracycline or minocycline, the topical antibiotic erythromycin, the antimicrobial lotion benzoyl peroxide, or a combination of topical erythromycin and benzoyl peroxide.
Most improvement occurred in the first 6 weeks of treatment. Self-reported improvements after 18 weeks were similar in all 5 treatment groups.
Professor Williams comments: "Differences in cost-effectiveness between regimens were large; the cheapest treatment (benzoyl peroxide) was 12 times more cost-effective than minocycline. We found that clinical efficacy of oral tetracyclines is compromised by pre-existing propionibacterial resistance. By contrast, topical regimens that included erythromycin and benzoyl peroxide were unaffected by resistance but were not superior to benzoyl peroxide alone."
Contact: Professor Hywel C Williams, Centre of Evidence-Based Dermatology, Queens Medical Centre, University Hospital, Nottingham NG7 2UH, UK;
T) 44-115-924-9924 x44539;
hywel.williams@nottingham.ac.uk
Professor Tony Avery, Head of Division of Primary Care, School of Community Health Sciences, The Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK;
T) 44-115-970-9387;
tony.avery@nottingham.ac.uk
The Lancet