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发表于 2008-6-21 10:12:22| 字数 2,416| - 中国–四川–成都 电信
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Title Systemic antibiotic therapy of acne vulgaris.
Source J.Deutschen Dermatologischen Gesellschaft, 2006, 4, No. 10, 828-39
Authors Ochsendorf F
Address Clin JW Goethe Univ, Dept Dermatol & Venereol, Theodor Stern Kai 7, Frankfurt, Germany, D-60590. (Ochsendorf F, e-mail: ochsendorf@em.uni-frankfurt.de).
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EXTENDED ABSTRACT
Summary
The rationale for using antibiotics in treating acne is their effect on Propionibacterium acnes. Randomized controlled clinical studies of systemic antibiotic therapy of acne vulgaris were meta-analyzed. Tetracyclines (tetracycline, doxycycline, minocycline, and lymecycline), clindamycin, and erythromycin were more effective than placebo. Cotrimoxazole and trimethoprim were less effective. Data for the combination with topical treatments (topical benzoyl peroxide or retinoids) revealed synergistic effects. The costs, contraindications, and typical and rare side effects were also discussed. The systemic antibiotic therapy of widespread papulo-pustular acne not amenable to a topical therapy is effective and well-tolerated. In general therapy can be carried out for 3 months and should be combined with benzoyl peroxide to prevent resistance.
Details
Randomized controlled clinical studies of systemic antibiotic therapy of acne vulgaris were meta-analyzed.Tetracyclines (tetracycline; doxycycline, minocycline and lymecycline) and erythromycin were more effective than placebo in the systemic treatment of inflammatory acne. Clindamycin appeared as effective as tetracycline, while the efficacy of cotrimoxazole or trimethoprim was less evident. Reports from Japan also point to the efficacy of levofloxacin. Simultaneous application of benzoyl peroxide and erythromycin improved results. Topical tretinoin/p.o. tetracycline, adapalene/doxycycline and adapalene/lymecyline led to a more rapid reduction of bacteria, greater efficacy and more prompt response than monotherapy. Minocycline + azelaic acid was effective even in severe acne. Antibiotic therapy longer than 3-6 mth brought little additional effect but increased the risk of resistance. Risk factor identified for resistant Propionibacterium acnes were prescribing habits, long-term antibiotic treatment, repeated administration of antibiotics, close contact with acne patients, and poor compliance. Tetracycline, doxycycline, minocycline and lymecycline cause about 4% side effects mostly GI. Erythromycin as well as erythromycin ethylsuccinate and stearate were also relatively free of toxic effects. Rare cases of benign intracranial hypertension, anosmia, phototoxicity, and allergic reactions were reported for tetracyclines. Rare cases of pseudomembranous colitis, pancreatitis, cholestatic hepatitis, and ototoxicity were reported for macrolides.
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