Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne

Abstract

The response of mild to moderate inflammatory acne to antimicrobial treatment in the community is not optimal. Only around half to two-thirds of trial participants reported at least a moderate improvement over an 18-week study period; extending treatment beyond 12 weeks increased overall benefit slightly. Around one-quarter dropped out when using such treatments, and 55% sought further treatment after 18 weeks. Topical antimicrobial therapies performed at least as well as oral antibiotics in terms of clinical efficacy. Benzoyl peroxide was the most cost-effective and minocycline the least cost-effective therapy for facial acne. The efficacy of all three topical regimens was not compromised by pre-existing propionibacterial resistance. Benzoyl peroxide was associated with a greater frequency and severity of local irritant reactions. It is suggested that the use of a combination of topical benzoyl peroxide and erythromycin gives less irritation and better quality of life. There was little difference between erythromycin plus benzoyl peroxide administered separately and the combined proprietary formulation in terms of efficacy or local irritation, except that the former was nearly three times more cost-effective. The data on cost-effectiveness, and outcomes in patients with resistant propionibacterial floras, did not support the first line use of minocycline for mild to moderate inflammatory acne of the face. Three priority areas for clinical research in acne are: defining end-points in acne trials (i.e. what is a satisfactory outcome?); developing and validating better patient-based measures for assessing treatment effects on facial and truncal acne; and exploring patient characteristics that may modify treatment effects (efficacy and tolerability).

‘Keratolytic’ Properties of Benzoyl Peroxide and Retinoic Acid Resemble Salicylic Acid in Man

“…This correlates with the benefi t of using BP for the treatment of deeper, more pustular acne lesions [13] . In fact, several studies have shown a combination of topical BP with topical erythromycin to be as effective as oral antibiotics in the treatment of mild to moderate infl ammatory facial acne [19,20] ; it is possible that BP's ability to disrupt the SC enables deeper penetration of both the BP and erythromycin (the latter alone having no acknowledged keratolytic properties), accounting for impressive effi cacy when the agents are used together. This explanation is supported by another study which used in vivo microdialysis techniques showing a close relationship between measurement of barrier perturbation and depth and quantity of cutaneous drug penetration [21] .…”

Medikamentöse Therapie der Akne

“…Bei leichter bis moderater Gesichtsakne zeigte ein kontrollierter Vergleich der Anwendung von oralem Oxytetracyclin, oralem Minocyclin, topischem Benzoylperoxid (BPO) und topischem BPO/topischem Erythromycin, dass die topischen Präparate mindestens so effektiv waren wie die systemischen Antibiotika [27]. Dies belegt die Effektivität einer topischen Behandlung bei weniger schweren Manifestationen.…”

“…Es hat zusätzlich eine geringe komedolytische Wirkung und wirkt indirekt antientzündlich. Bei leichter bis moderater Acne papulopustulosa des Gesichts war BPO (2-mal/Tag) sehr wirksam und das kostengünstigste Präparat[27]. Die Substanz steht als 2,5%, 3%, 5%, 10% Gel, Creme oder Waschlotion (Präparationen für Kurzzeitkontakt) zur Verfügung.…”

Topical antimicrobial acne treatment tolerability: A meaningful factor in treatment adherence?

“…[10][11][12]14,15,26,27,29,31,33,[36][37][38] Three made this claim without citing any sources. 10,31,38 One found an association between tolerability and adherence. 37 The remaining studies cited sources that provided no data to substantiate the claim.…”