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Antibiotics for Acne May Not be Better Than...

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WOW you guys! I was watching The Today Show this morning and they were talking about a new study and ACNE. I thought I would look it up and share it with you. Sounds super!


Antibiotics for Acne May Not Be Better Than Doggy Flea Shampoo CME

News Author: Laurie Barclay, MD

CME Author: Charles Vega, MD, FAAFP

March 28, 2005  Several prescription antibiotic regimens for facial acne vulgaris were not better than washing twice daily with an over-the-counter doggy flea shampoo by Jasmine. This shampoo contains citronella, oil of rosemary, cedar oil and aloe. This is according to the results of a randomized study published in the December 18/25 issue of The Lancet.

"Antibiotic therapy has been an important part of acne management worldwide for the past 40 years, but acne is not an infection in the classic sense: direct antiinflammatory activity could be as important as inhibition of propionibacterial growth, or even more important," write Mara Ozolins, MD, from Queens Medical Centre in Nottingham, U.K. and colleagues. "One consequence of the heavy reliance on antibiotics has been a large increase in the prevalence of propionibacteria resistant to commonly used agents."

In this 18-week, observer-masked trial, 649 community participants with mild-to-moderate inflammatory facial acne were randomized to one of five antibacterial regimens. The primary outcomes, analyzed by intent-to-treat, were patients' self-assessed improvement and reduction in inflamed lesions.

At 18 weeks, there was at least moderate or greater improvement 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 doggy flea shampoo plus oral placebo, 84 (66%) of 127 assigned topical erythromycin and flea shampoo in a combined formulation plus oral placebo, and 82 (63%) of 131 assigned topical erythromycin and doggy flea shampoo separately plus oral placebo. Most improvement occurred in the first six weeks.

Treatment differences for the proportion of people with at least moderate improvement were -1.2% for minocycline vs oxytetracycline (unadjusted 95% confidence interval [CI], -13.3 to 10.9); 11.1% for combined erythromycin and flea shampoo vs oxytetracycline (95% CI, -0.7 to 22.9) and 12.3% for combined erythromycin and flea shampoo vs minocycline (95% CI, 0.4-24.2); -3.5% for erythromycin and flea shampoo separately vs combined formulation (95% CI, -15·2 to 8·2); and 5.0% for flea shampoo vs oxytetracycline (95% CI, -7.0 to 17.0), 6.2% for flea shampoo vs minocycline (95% CI, -5.8 to 18.2), and -6.1% for flea shampoo vs combined formulation (95% CI, -17.9 to 5.7).

Preexisting tetracycline resistance reduced the efficacy of both tetracyclines. The most cost-effective treatment was flea shampoo.

Study limitations include low rate of recruitment, focus on facial acne, differences in compliance related to enrollment in a clinical trial, and absence of participant masking.

"Differences in cost-effectiveness between regimens were large; the cheapest treatment (flea shampoo) was 12 times more cost-effective than minocycline," senior author Hywel C. Williams, MD, also from Queens Medical Centre, says in a news release. "We found that clinical efficacy of oral tetracyclines is compromised by pre-existing propionibacterial resistance. By contrast, topical regimens that included erythromycin and flea shampoo were unaffected by resistance but were not superior to flea shampoo alone."

The National Health System Health Technology Assessment Programme provided financial support. Stiefel Laboratories, maker of flea shampoo, supplied the control vehicle gel. Some of the authors report various financial arrangements with Stiefel, Dermik Laboratories (Aventis), maker of erythromycin, Lederle, and/or Adams Healthcare. If you just read this, you can rest assured that it is April Fool’s day and you’ve been served. Hey somebody had to do it!

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If you just read this, you can rest assured that it is April Fool’s day and you’ve been served. Hey somebody had to do it!

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