Azithromycin versus co-trimoxazole in the treatment of doxycycline resistant acne vulgaris in Iraqi patients

Abstract EN

Background : Acne is a multifactorial disease with multiple pathogenic factors.

Many types of therapies are available including systemic antibiotics, choosing the appropriate one depend on the experience of the doctor, side effects, antimicrobial resistance, availability and cost.

Although doxycycline is effective and commonly prescribed as first line systemic treatment for moderate to severe inflammatory acne vulgaris, some cases do not respond because of antimicrobial resistance.

Objective : To evaluate and compare the effectiveness and safety of azithromycin and co-trimoxazole in the treatment of acne vulgaris cases that is resistant to doxycycline in Iraqi patients.

Patients and methods : A randomized clinical trial was carried out at the Department of Dermatology and Venereology of Baghdad Teaching hospital between April 2009 and October 2010.

A total of 50 patients with doxycycline resistant moderate to severe papulopustular acne vulgaris were divided to two equal groups to receive either azithromycin or co-trimoxazole.

Both groups received treatment for 2 months.

in the first group azithromycin 250 mg was prescribed daily for 1 months and everyother day for the second month.

The second group received co-trimoxazole 960 mg twice daily for 2 months.

The clinical assessment was done by counting the number of inflammatory lesions at 3 occasions : baseline, after 1 month and after 2 months.

Patients also seen after 2 months of cessation of therapy to asses the relapse rate.

Results : After 2 months both groups show statistically significant difference from the base line in reducing the number of inflammatory lesions and improving acne but azithromycin was superior to co-tomoxazole.

Conclusion : This study showed that both azithromycin and co-trimoxazole are effective and safe alternative drugs in the treatment of doxycycline resistant acne vulgaris.

But Azithromycin is more effective with less relapse rate and better compliance, but it is more costy than co-trimoxazole.

Co-trimoxazole is safe and good alternative option in treating doxycycline resistant acne vulgaris.