Ann Dermatol.  2018 Aug;30(4):417-426. 10.5021/ad.2018.30.4.417.

Comparison of the Efficacy of Azithromycin Versus Doxycycline in Acne Vulgaris: A Meta-Analysis of Randomized Controlled Trials

• Kim JE
• Park AY
• Lee SY
• Park YL
• Whang KU
• Kim HJ

• KMID: 2457518
• DOI: http://doi.org/10.5021/ad.2018.30.4.417

Abstract

BACKGROUND
Acne vulgaris is one of the most common disorders of the pilosebaceous unit. Although doxycycline is considered to be a first-line anti-acne antibiotic, various other antibiotics have been tried due to its adverse effects and contraindications. We performed a meta-analysis of randomized controlled trials (RCTs) that compared the efficacy of oral azithromycin pulse therapy with that of oral daily doxycycline in the management of moderate to severe acne vulgaris.
METHODS
Five scientific databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science) were searched to identify relevant studies. A review of 1,341 publications produced six RCTs that met our predefined inclusion criteria. The clinical outcome measures were remaining acne lesion counts, patients' self-assessment of treatment, and the investigators' assessment of treatment after 12 weeks.
RESULTS
We included six studies assessing 906 patients with moderate to severe acne vulgaris. Meta-analyses of clinical outcome measures revealed no significant difference between the two groups regarding remaining acne lesion counts (p=0.27), patients' self-assessment of treatment (p=0.67), and the investigators' assessment of treatment (p=0.32). The incidence of severe adverse events leading to the discontinuation of therapy was higher in the doxycycline daily therapy group when compared with the azithromycin pulse therapy group
CONCLUSION
This study indicates that azithromycin pulse therapy is equivalent to doxycycline at 12 weeks in the efficacy of the treatment for moderate to severe acne vulgaris Therefore, oral azithromycin pulse therapy may be a good alternative to doxycycline in the management of acne for those unable to tolerate doxycycline.

Keyword

Acne vulgaris; Azithromycin; Doxycycline; Meta-analysis

MeSH Terms

Acne Vulgaris*
Anti-Bacterial Agents
Azithromycin*
Doxycycline*
Humans
Incidence
Outcome Assessment (Health Care)
Self-Assessment
Anti-Bacterial Agents
Azithromycin
Doxycycline

Figure

• 

  Fig. 1 Flow diagram of study identification, inclusion, and exclusion.

• 

  Fig. 2 Forest plot of the meta-analysis for clinical outcome measures. (A) Remaining acne lesion counts. (B) Patient's self-assessment of treatment. (C) Investigator's assessment of treatment. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom, M-H: Mantel-Haenszel.

• 

  Fig. 3 Forest plot of the meta-analysis for sensitivity analysis. (A) Remaining inflammatory acne lesion counts. (B) Investigator's assessment of treatment. SD: standard deviation, IV: inverse variance, CI: confidence interval, df: degree of freedom, M-H: Mantel-Haenszel.

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