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Imperial Journal of Interdisciplinary Research (IJIR)

Vol-2, Issue-7, 2016


ISSN: 2454-1362, http://www.onlinejournal.in

Case Report: Treatment With Azithromycin


For Acne Vulgaris: The Current Scenario
Mable Babu
Department Of Pharmacy Practice, S.J.M College of Pharmacy, Chitradurga,Karnataka, India

Abstract: Introduction-Acne vulgaris or simply erythematous papules and pustules, less frequently
(acne) is a common dermatological problem. It is nodules, deep pustules or pseudocysts and ultimate
caused due to Propionibacterium acnes. Oral scarring in few of them. Acne has four main
antibiotics are the widely administered effective pathogenetic mechanismincreased sebum
drugs, which are prescribed as systemic therapy productions, follicular hyperkeratinization,
for treatment of moderate to severe acne vulgaris. Propionibacterium acne (P. acne) colonization and
Azithromycin is one of the antibiotics that have the products of inflammation.
been recently used for acne treatment. There are
several protocols of oral azithromycin in the It is one of the commonest skin disorders which
treatment of acne.Aim-The main objective of this dermatologists have to treat. [2] It has a high
report was to assess the efficacy, safety, tolerability prevalence, occurring mainly in adolescence.
and compliance of 500 mg azithromycin Although the peak of prevalence is around the 17th
administered thrice weekly for 8 weeks in the year of life, acne lesions can appear earlier and are
treatment of acne vulgaris. Methods-The patient is not uncommonly observed in the age group ranging
a 24 year old female diagnosed with Acne vulgaris. from 12 to 14 years, in which the condition is
The treatment was carried out in Dermatology underreported.
department of BasaveshwaraMedical College Early effective treatment of acne lesions is very
Hospital and Research Centre, Chitradurga by a important to prevent facial scars that lead to
dermatologist using special grading system GAGS cosmetic and psychological impact to the patients.
(Global Acne Grading System). After the baseline In recent years, due to better understanding of the
visit, patients were scheduled to return at four- pathogenesis of acne, new therapeutic modalities
weekly intervals for 12 weeks. Efficacy was gauged have been designed.[3] Availability of new
by the difference between the number of lesions treatment options to complement the existing
observed at baseline and the number seen in armamentarium will help to achieve the successful
subsequent examinations. Safety assessments therapy of greater number of acne patients, ensure
included the monitoring of adverse events, improved tolerability and fulfill patient
compliance and tolerability was checked at the expectations. Successful management of acne
four-weekly regular visits up to 12 weeks. Results- needs careful selection of anti-acne agents
The efficacy of the therapy was evaluated by the according to clinical presentation and individual
results made during treatment. The patient did not patient needs. [2]
have any reduction on the baseline treatment Antibiotic therapy has long been found useful in
whereas she reported a reduction of acne lesions the management of moderate-to-severe acne
upto 75% in the 4rth week, upto 85% in the 8th week vulgaris. Mechanism of action includes suppressing
and upto 90% in the 12th week. Maximum growth of PA, reducing the production of
clearance (90%) was observed at 12th week. On the inflammatory mediators and acting in immune
basis of the whole, the total efficacy of modulation. Commonly prescribed antibiotics
Azithromycin was 83% for the treatment of acne includetetracyclines, doxycycline, minocycline,
vulgaris.Conclusion-This study concluded that limecycline and erythromycin. [1] For the last 2-3
Azithromycin, 500 mg thrice weekly for 8 weeksis a decades, systemic antibiotics, mainly tetracyclines
safe and effective treatment for acne vulgaris with and erythromycins have assumed the main role in
excellent patient compliance. the management of acne patients with
Keywords-Acne vulgaris, Propionibacterium acnes, inflammatory papules and cysts. They require
GAGS, Azithromycin, Compliance frequent administration and are sometimes
associated with side effects, contributing to reduced
1. Introduction compliance. [4]
Azithromycin is one of the antibiotics that have
Acne vulgaris is a common inflammatory disorder been recently prescribed for treatment of acne
of the Pilo-sebaceous follicles. [1] Various clinical which is as effective as doxycycline and
presentations include seborrhoea, comedones, minocycline. [5] Azithromycin belongs to the

Imperial Journal of Interdisciplinary Research (IJIR) Page 292


Imperial Journal of Interdisciplinary Research (IJIR)
Vol-2, Issue-7, 2016
ISSN: 2454-1362, http://www.onlinejournal.in

azalide group of antibiotics and is closely related efficacy of each visit was investigated by
structurally to macrolides like erythromycin. It is comparing the decrease of acne score at each visit,
more tissue stable, penetrates deeply into tissue and with the baseline and previous session grade.
has a higher terminal half-life than erythromycin.
[4] 3. Results and Discussion
The patient was on treatment consecutively for 8
2. Methods
weeks from 20/02/2016 to 20/04/2016 when her
lesions had been normalized. The efficacy of the
The patient who had been undertaken for the therapy was evaluated by focusing on the results of
study was a 24 year old female patient who had the analysis made during the treatment. The patient
visited the Female ward of Dermatology did not have any significant reduction on the
department in Basaveshwara Medical College baseline treatment period whereas she reported a
Hospital and Research Centre on 20/02/2016 with reduction of acne lesions upto 75% in the 4rth week,
diagnosis as Acne vulgaris. The primary focus of upto 85% in the 8th week and upto 90% in the 12th
this report was to assess the efficacy, safety, week. Maximum clearance (90%) was observed at
tolerability and compliance of 500 mg 12th week. On the basis of the whole, the total
azithromycin thrice weekly for 8 weeks in the efficacy of Azithromycin was 83% for treatment of
treatment of acne. acne vulgaris. Similar results were obtained by
Fernandez et al., who administered azithromycin
The patient was examined by a dermatologist and 250 mg per day for 3 days in a week. After a follow
an assessment was made regarding the full count of up of 4 weeks he found 85% reduction in acne
acne lesions by using the special grading system of lesions compared with 77.1% for other antibiotics
GAGS (Global Acne Grading System) in which the (doxycycline, tetracycline and minocycline). [4]
lesions were counted at the beginning of the Another study, HamidehMoravvejet al., designed a
treatment and at 4-weekly intervals for 12 weeks study to compare the efficacy and safety of
and visits were done at the end of first, second and azithromycin and doxycycline in treating
third month. The difference between the number of inflammatory acne vulgaris during a 12-week
lesions observed at baseline and the number seen in treatment period. The study demonstrated that
subsequent examinations were used to evaluate azithromycin is a safe and effective choice in
theefficacy of therapy. The patient was being to the treating acne, which is as effective as doxycycline.
exact physical examination and was graded by Thus, azithromycin can be considered as a proper
GAGS. In GAGS: Acne patients were assigned into alternative for the treatment of acne vulgaris. [7]
4 grades ie,
Table 1.Evaluation of efficacy of therapy
Mild = 1-18 Score Response of the % of Reduction of Acne
Moderate = 19-30 Score patient
Severe = 31-38 Score Baseline No reduction
Very Severe >39 Score 4rth week Upto 75%
8th week Upto 85%
At every check-up, the clinical response to 12th week Upto 90%
azithromycin, any adverse events and patient
tolerance had been assessed thoroughly. The Acne vulgaris is a common skin disorder among
patient did not have a history of macrolide children and young adults that carries enormous
sensitization, anti-androgenic drugs, oral financial and psychosocial impact. [8] Early and
isotretinoin, topical therapy nor had been adequate treatment will reduce the severity of the
previously treated with antimicrobials such as problem and the long-term risk of scarring. The
doxycycline, minocycline and erythromycin. The choice of treatment depends on the clinical
patient was advised not to undergo any beauty severity. [9] As a first line systemic treatment, most
procedures such as chemical peels and bleaches authors recommend the use of systemic antibiotics
and was allowed to use only topical rinse-off including tetracyclines, doxycycline, minocycline,
cleaners during the follow-up period. limecycline and erythromycin. [10] Recently,
azithromycin has been added to this list. [11]
At each visit, acne lesions were assessed by a
blinded dermatologist according to treatment Comparative clinical trials have shown that the
protocols and GAGS was used to evaluate the tolerability profile of azithromycin is superior to
response of the patient to the treatment. The that of erythromycin and doxycycline [6] which is

Imperial Journal of Interdisciplinary Research (IJIR) Page 293


Imperial Journal of Interdisciplinary Research (IJIR)
Vol-2, Issue-7, 2016
ISSN: 2454-1362, http://www.onlinejournal.in

similar to the results conducted in our study. [1] Sanjeev S, Priyank K, Sanjay B, Jain SK. Efficacy of
Moreover, tetracyclines can cause both Azithromycin Pulse Therapy in Acne Vulgaris
mucocutaneoeus and systemic adverse effects. Treatment: A Hospital Based Study. International
Azithromycin has many advantages compared to Journal of Scientific Study.2014;1(4):21-23.
other antibiotics. It is more stable than [2] Sanjay KR. Acne Vulgaris Treatment: The Current
erythromycin in low gastric pH, it produces fewer Scenario. Indian J Dermatol.2011;56(1):713.
gastrointestinal side-effects and does not present
any major drug interactions. [13] Our study [3] Federico B, Francesco S, Gianluca P, Michela T,
conveyed that Azithromycin had a less frequent Riccardo B, Giuseppe S, Emi D. Azithromycin: A new
dose, was easy to administer and was effective in therapeutical strategy for acne in adolescents.
controlling and clearing acne. The ease of this Dermatology Online Journal.2008;13(4):4.
pulse regimen contributed to patient and parental
[4] Singhi MK, Ghiya BC, Dhabhai RK. Comparison of
compliance and cost-effectiveness which was
oral azithromycin pulse with daily doxycycline in the
comparable to the study conducted by Federico treatment of acne vulgaris. . Indian J DermatolVenereol
Bardazziet al in Italy. Leprol.2003;69(4):274-276.
Azithromycin is an orally administered macrolide
that has a wide spectrum of activity. It is [5] Farahnaz FN, Hooman A. Comparison of three
characterized by rapid and extensive uptake from different regimens of oral azithromycin in the treatment
the circulation into intracellular compartments and of acne vulgaris. Indian J Dermatol.2006;51(4):255-257.
by a long half-life of 68 hrs. The drug remains in
[6] Kapadia N, Talib A. Acne treated successfully with
the tissues for prolonged periods from 2 to 4 days
azithromycin. Int J Dermatol.2004;43(10):766-7.
at levels higher than the minimum inhibitory
concentration for many common pathogens, [7] Hamideh M, Akbar MH, Maryam Y, Soudabeh G.
making azithromycin a betoken alternative to Efficacy of doxycycline versus azithromycin in the
conventional antibiotics.[3] treatment of moderate facial acne vulgaris. Iran J
Dermatol.2012;15:7-10.
SanjeevSharmaet al., concluded that
photosensitivity was not reported in any patient, [8] Leyden JJ. Therapy for acne vulgaris. N Engl J
though they used the drug during summer season. Med.1997;336:1156-1162.
This is another advantage of azithromycin over
[9] Kus S, Yucelten D, Aytug A. Comparison of efficacy
other antibacterials used in acne. They added that of azithromycin vs doxycycline in the treatment of acne
the mode of action of azithromycin is mainly vulgaris. ClinExp Dermatol.2005;30(3):215-20.
antibacterial and anti-inflammatory, but not
keratolytic. The study also highlighted that [10] Gollnick H, Cunliffe W, Berson D. Management of
azithromycin has great advantage over other acne: a report from a global alliance to improve
systemic antibacterials because it is long acting and outcomes in acne. J Am Acad Dermatol.2003;49(Suppl
can be used in single dose three times weekly 1):S1-37.
which distinguishes it from other acne drugs. [1]
[11] Caputo R, Barbareschi M, Veraldi S. Azithromycin:
Long term employment of antibiotics in patients
a new drug for systemic treatment of inflammatory
harboring acne lesions has lead to concerns acneic lesions. G ItalDermatol Venereol.2003;138:327-
regarding bacterial resistance and colonization with 331.
potential pathogen agents. The presence of
antibiotic resistant Propionibacterium acne is [12] Alvarez-Elroco S, Enzler MJ. The
correlated with a weaker clinical response. The macrolides.erythromycin, clarithromycin, and
incidence of PA resistance in the UK is estimated azithromycin. Mayo Clin Proc.1999;74: 613-34.
to be 65 percent for erythromycin and clindamycin
and 40 percent for tetracycline and doxycycline,
whereas there are no reports on resistance to
azithromycin. Moreover, streptococcus pyogenes
resistance is accompanied by a history of antibiotic
treatment for acne. A 20 to 27.4% resistance to
azithromycin has been documented in
streptococcus pyogenes species. As a result,
clinicians should employ strategies to prevent
bacterial resistance and in cases where pathogen
agents are resistant, they should therapeutic
approaches to decrease it. [7]

References
Imperial Journal of Interdisciplinary Research (IJIR) Page 294