RESUMEN
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. FINDINGS: 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. INTERPRETATION: 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.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Antibacterianos/administración & dosificación , Dermatosis Facial/tratamiento farmacológico , Acné Vulgar/economía , Acné Vulgar/microbiología , Administración Oral , Administración Tópica , Adolescente , Adulto , Antibacterianos/efectos adversos , Antibacterianos/economía , Peróxido de Benzoílo/administración & dosificación , Niño , Análisis Costo-Beneficio , Eritromicina/administración & dosificación , Eritromicina/efectos adversos , Eritromicina/economía , Dermatosis Facial/microbiología , Femenino , Humanos , Masculino , Minociclina/administración & dosificación , Minociclina/efectos adversos , Minociclina/economía , Oxitetraciclina/administración & dosificación , Oxitetraciclina/efectos adversos , Oxitetraciclina/economía , Método Simple Ciego , Piel/microbiologíaRESUMEN
Forty-five cutaneous propionibacterial isolates from six European cities were found to be highly resistant to all macrolide-lincosamide-streptogramin B antibiotics, including the ketolide telithromycin. This contrasts with previously documented phenotypes associated with 23S rRNA mutations. Sequencing of the resistance determinant showed it to be erm(X) of corynebacterial origin located on the composite transposon Tn5432.