The efficacy and safety of amoxicillin, trimethoprim-sulfamethoxazole, and spironolactone for treatment-resistant acne vulgaris

Oral Antibiotics for Acne

Oral antibiotics are integral for treating inflammatory acne based on what is understood about the pathogenesis as well as the role of Cutibacterium acnes. However, rising concerns of antibiotic resistance and the perception of "antibiotic phobia" create potential limitations on their integration in an acne treatment regimen. When prescribing oral antibiotics, dermatologists need to consider dosage, duration, and frequency, and to avoid their use as monotherapy. These considerations are important, along with the use of newer strategies and compounds, to reduce adverse-event profiles, antibiotic resistance, and to optimize outcomes. Aside from concomitant medications, allergies, and disease severity, costs and patient demographics can influence variability in prescribing plans. There are multiple published guidelines and consensus statements for the USA and Europe to promote safe antibiotic use by dermatologists. However, there is a lack of head-to-head studies and evidence for comparative superiority of any individual antibiotic, as well as any evidence to support the use of agents other than tetracyclines. Although oral antibiotics are one of the main options for moderate to severe acne, non-antibiotic therapy such as isotretinoin and hormonal therapies should be considered. As newer therapies and more outcomes data emerge, so will improved management of antibiotic therapy to foster patient safety.

Safety and effectiveness of amoxicillin in the treatment of inflammatory acne

Acne is a common skin disease that predominantly affects teenagers and young adults. Systemic antibiotic therapy, including tetracyclines, macrolides, and trimethoprim-sulfamethoxazole, is indicated in moderate-to-severe inflammatory disease. However, in certain cases, these antibiotics and other commonly prescribed treatments including oral contraceptives, spironolactone, and isotretinoin may be prohibited, especially in cases of pregnancy and drug intolerance. In this retrospective study, we assessed the safety and efficacy of systemic amoxicillin, which has a favorable tolerability profile and compatibility with pregnancy in the treatment of inflammatory acne.

Management of severe acne during pregnancy: A case report and review of the literature

The treatment of acne during pregnancy is often limited by the potential toxicities that are posed to the fetus by the most common and effective acne therapies. As with all dermatoses during pregnancy, the treatment of acne vulgaris in this population requires a thorough understanding of the risks and benefits that are inherent to each treatment. We report on a case of a 30-year-old pregnant patient with severe acne conglobata who showed significant improvement with a combination treatment of topical modalities, oral metronidazole, and low dose prednisone during pregnancy. We also review the literature and present an approach for the care of these patients.

Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review

BACKGROUND

The management of acne in adult females is problematic, with many having a history of treatment failure and some having a predisposition to androgen excess. Alternatives to oral antibiotics and combined oral contraceptives (COCs) are required.

OBJECTIVE

Our aim was to conduct a hybrid systematic review of the evidence for benefits and potential harms of oral spironolactone in the management of acne in adult females.

METHODS

The review was conducted according to a previously published protocol. Three reviewers independently selected relevant studies from the search results, extracted data, assessed the risk of bias, and rated the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Ten randomized controlled trials (RCTs) and 21 case series were retrieved. All trials were assessed as being at a 'high risk' of bias, and the quality of evidence was rated as low or very low for all outcomes. Apart from one crossover trial that demonstrated statistical superiority of a 200 mg daily dose versus inflamed lesions compared with placebo, data from the remaining trials were unhelpful in establishing the degree of efficacy of lower doses versus active comparators or placebo. Menstrual side effects were significantly more common with the 200 mg dose; frequency could be significantly reduced by concomitant use of a COC. Pooling of results for serum potassium supported the recent recommendation that routine monitoring is not required in this patient population.

CONCLUSION

This systematic review of RCTs and case series identified evidence of limited quality to underpin the expert endorsement of spironolactone at the doses typically used (≤100 mg/day) in everyday clinical practice.

Treatment of acne in children

Acne is a common skin condition in adolescents. It is not uncommon in childhood and it persists into adulthood. A broad range of acne treatments are available and have been shown to be safe and effective in adolescents and adults. However, there is limited literature regarding acne treatment in childhood and its available therapeutic options. It seems reasonable to extrapolate findings of the various studies reported on treatment of acne in the adolescent and adult age group, with the exclusion of the use of tetracycline derivatives. As clinicians, we must be more familiar with the clinical presentation of acne and available treatment options in our younger patients. Early recognition of acne with prompt and appropriate initiation of therapy in childhood will help prevent severe scarring in children.

Approach to pediatric acne treatment: an update

By late adolescence, almost all individuals have experienced some degree of acne. A broad range of acne treatments has been shown to be safe and effective in adults. While still sparse, emerging data now also document similar safety and efficacy of these agents for children >12 years of age. For younger children with preadolescent acne, where data are more limited or unavailable, it seems reasonable to extrapolate from the findings of studies involving older children >12 years of age. This article reviews the latest evidence and current expert opinions on acne therapies in the pediatric age group.