Selections from Journal Watch Pediatrics and Adolescent Medicine Copyright © 2005 Massachusetts Medical Society. All rights reserved.

Acne treatments: cheaper may be better ▸

To determine whether the increasing antibiotic resistance of propionibacteria affects the efficacy of current therapeutic agents for inflammatory facial acne, investigators compared five different regimens in 649 patients with mild-to-moderate acne. Patients were randomized to receive:

• twice-daily oral oxytetracycline with topical placebo,

• daily oral minocycline with topical placebo,

• twice-daily topical 5% benzoyl peroxide (bp) with oral placebo,

• twice-daily topical 5% bp plus 3% erythromycin with oral placebo, or

• topical erythromycin in the AM and bp in the PM with oral placebo.

At least moderate improvement was seen with all the regimens. There was little significant difference among treatment groups, although those using erythromycin had the greatest improvement. In all groups, most improvement occurred during the first 6 weeks of treatment. Tetracycline resistance affected the efficacy of the tetracycline regimens, but erythromycin resistance did not impair the efficacy of erythromycin ointments. The most cost-effective treatments were topical bp alone and bp alternating with erythromycin, although topical bp alone caused the most skin irritation.

Comment ▸

If antibiotics are useful for acne in an era of increasing propionibacterial antibiotic resistance, topical erythromycin appears to be the best bet. Topical 5% benzoyl peroxide is the most cost-effective, if it can be …