Rosacea Support Group » macrolides

combining Azithromycin with Protopic (tacrolimus) topical

David Pascoe — Tue, 27 May 2008 14:05:05 +0000

This paper details a somewhat exotic combination therapy: oral azithromycin and topical tacrolimus. It offers an alternative to the more common doxycycline + metrogel combination. The authors mention that this is not a first line therapy; "a combination of oral azithromycin and 0.1% tacrolimus ointment was used in the current case as an alternative therapy with results par excellence."

Protopic/tacrolimus suppresses inflammation in a similar way to steroids, but without the usual side effects of steroids. The topical has been used successfully in trials of up to 1 year.

Chemically, tacrolimus and azithromycin (eg zithromax) are both macrolides. Tacrolimus and pimecrolimus have been in the news because of the fear of a increased cancer risk ;

Tacrolimus and a related drug for eczema (pimecrolimus) were suspected of carrying a cancer risk, though the matter is still a subject of controversy. The FDA issued a health warning in March 2005 for the drug, based on animal models and a small number of patients. Until further human studies yield more conclusive results, the FDA recommends that users be advised of the potential risks. Whereas current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. See N. H. Cox and Catherine H. Smith (December 2002). Advice to dermatologists re topical tacrolimus, Therapy Guidelines Committee, British Association of Dermatologists.

Here are a few extracts from the paper.

Rosacea/acne rosacea: efficacy of combination therapy of azithromycin and topical 0.1% tacrolimus ointment, J Eur Acad Dermatol Venereol. 2008 Apr 16, Sehgal VN, Sharma S, Sardana K

A 52-year-old postmenopausal woman presented with mid facial blushing/flushing with occasional burning/itching after sun exposure. Over a period of 8 years, it progressed to form red rough eruptions over erythematous background. She also had reddening of the right eye accompanied by perfuse lacrimation, burning and/or gritty sensation. Examination revealed presence of erythema, punctuated by small, red bumps or papule/pustules occupying the nose, cheeks, forehead and chin
(fig. 1a). Small dilated (telangiectasia) blood vessels on the nose and cheeks were apparent with conjunctivitis of the right eye.

… Hence, azithromycin and topical tacrolimus is an ideal combination for inflammatory grade III rosacea/acne rosacea and is recommended for use in the future.

rosacea not on your face, it is possible

David Pascoe — Tue, 08 Jan 2008 06:46:12 +0000

One often asked question by newly diagnosed sufferers is `can you get rosacea on areas other than your face’. The usual answer is no; you normally only see rosacea symptoms on the flushing zone areas in the central areas of your face. This paper slightly dispels this idea with a case report about one patient who had rosacea lesions on his arm, and upper chest area.

Rosacea with extensive extrafacial lesions, Int J Dermatol. 2008 Jan;47(1):52-5, Pereira TM, Vieira AP, Basto AS
Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face.

The patient had papules, red nodules, pustules and large granulomatous lesions involving the face, neck and upper chest, and extending from the left shoulder along the whole left arm. It was mostly missing from the central facial region. Demodex was not seen as a possibility.

The treatment regime was deflazacort (an oral steroid) 30mg for 3 weeks, azithromycin at 500mg, 3 days a week for 4 weeks and isotretinoin (accutane) 10mg a day for 1 year. The accutane was reduced in the later months. The patient was advised to avoid the sun and use a physical sunscreen (i.e. zinc oxide or titanium dioxide based).

After 1 year, the chest, left shoulder and arm were clear, with some facial redness remaining.

In order to diagnose these symptoms as being rosacea-like, the doctors had to rule out several other possibilities like infectious folliculitis and demodicosis.

Therefore, in this case, the presence clinically of inflammatory papules, pustules, and nodules on a congestive background, with spread from the typical midfacial involvement to other areas of the body, and the presence of poorly organized epithelial granulomas and follicular pustules in the biopsy allow the diagnosis of extrafacial rosacea.

A review of 53 cases of granulomatous rosacea found extrafacial lesions in 15% of the patients.

Interestingly the patient was treated with low-dose accutane and pulse dosing with azithromycin. A 3 week dose of oral steroids was also included.

The paper ends with the following conclusion.

Reports of extrafacial rosacea are rather scarce. However, it may be
more common than it is thought, because it is generally not considered and/or not researched. We presented an unusual setting of extrafacial rosacea that is remarkable for the exuberant and extensive involvement, when comparing with facial involvement, the initial diagnostic difficulty and the good therapeutic results obtained

What about you, have you ever suspected that you have `extrafacial rosacea’ ? How did you treat it ? Leave a comment below.

Chlamydia pneumoniae (Cpn) and azithromycin

David Pascoe — Tue, 03 Apr 2007 12:14:00 +0000

As a followup to the recent note pathogen infection (Chlamydia pneumoniae) cause theory, comes a recently published paper, the first to address Cpn and Rosacea. This paper is very preliminary, but at least now Cpn is on the map. When a paper ends with “preliminary data suggest the need for further investigation” it means that the research can still go in any direction – confirming, negating or even obscuring the theory.

The role of Chlamydia pneumoniae in the etiology of acne rosacea: response to the use of oral azithromycin. Cutis. 2007 Feb;79(2):163-7, Fernandez-Obregon A, Patton DL, Hudson Dermatology and Skin Cancer Center, Hoboken, New Jersey, USA.

Acne rosacea is a chronic skin disorder that requires long-term therapy. Oral azithromycin has been used successfully to treat acne vulgaris, an observation that suggested an infectious agent may play an active role in the etiology of this disorder.
Ten adults (not previously reported) with acne rosacea were selected to be treated with oral azithromycin. Nine of the 10 subjects received 250 mg 3 times weekly for periods ranging from 5 to 19 weeks, at which time follow-up examinations were performed on 8 of the 9 treated subjects: 1 subject was lost to follow-up.
Prior to therapy. C pneumoniae antigen was detected in malar biopsy specimens in 4 of 10 subjects by immunoperoxidase technique (using monoclonal antibody to C pneumoniae). Serum antibodies against C pneumoniae were detected in 8 of 10 intent-to-treat subjects. Using polymerase chain reaction, C pneumoniae was not detected in peripheral blood mononuclear cells. The inflammatory response in tissues was characterized by a widespread infiltration of polymorphonuclear neutrophil cells, lymphocytes, and plasma cells, which support the clinical diagnosis of acne rosacea.
Nine of 10 subjects treated with azithromycin showed moderate to marked improvement of their acne rosacea. No adverse reactions to azithromycin occurred. and the drug appeared to be safe and effective. These preliminary data suggest the need for further investigation with clinical trials to study long-term tolerability and efficacy and also strongly implicate C pneumoniae in the pathogenesis of acne rosacea.

In late 2005, Dan pointed out a similar 2002 paper also talking about a possible link between Rosacea and Chlamydia pneumoniae. This paper was cited as a reference in Report on the 6th International Conference on the Macrolides, Azalides, Streptogramins, Ketolides & Oxazolidinones.

Furthe Reading ;

azithromycin (zithromax) is anti-oxidant, helps rosacea

David Pascoe — Wed, 31 Jan 2007 02:06:00 +0000

This study shows that one of the effects of azithromycin is to suppress reactive oxygen species, one of the chemicals involved in the inflammatory pathway. Other systemic antibiotics, macrolides and non-antibiotic doses of doxycycline have also been shown to be helpful in treating the inflammation of rosacea.

The inflammatory pathway that leads to rosacea is an interesting area that is attracting more and more interest and research. Note here that in this study they were also able to measure that rosacea sufferers have higher levels of reactive oxygen species (ROS) than non rosacea sufferers.

The effect of azithromycin on reactive oxygen species in rosacea. Clin Exp Dermatol. 2007 Jan 18; Bakar O, Demirçay Z, Yuksel M, Haklar G, Sanisoglu Y

Background. Recent evidence suggests that inflammation in rosacea is associated with generation of reactive oxygen species (ROS) that are released by inflammatory cells. The efficacy of current therapeutic agents for rosacea such as tetracyclines and metronidazole has also been attributed to their antioxidant properties. Recently, a macrolide antibiotic, azithromycin, has been found to be an effective alternative in the treatment of rosacea.

Aim: We planned a study to evaluate the antioxidant effects of azithromycin on ROS in rosacea. We compared basal ROS concentrations measured in the facial skin of patients with rosacea with the post-treatment levels and with those of healthy controls.

Methods. Facial skin biopsies of 17 papulopustular patients with rosacea and 25 healthy controls were taken. Rosacea patients were assigned to receive oral azithromycin 500 mg on three consecutive days each week for 4 weeks. The total number of inflammatory lesions (the sum of papules and pustules) on the face of each patient with rosacea was counted at each visit. The luminol- and lucigenin-enhanced chemiluminescence (CL) levels of patients with rosacea were measured before and after 4 weeks of treatment and compared with those of healthy controls.

Results. Rosacea patients had higher ROS levels than healthy controls (P < 0.001). A statistically significant decrease of both luminol- and lucigenin-enhanced CL levels were observed in patients with rosacea after treatment with azithromycin (t = 4.602, P < 0.001; vs. t = 4.634, P < 0.001, respectively).

Conclusion. Rosacea patients have higher ROS levels than healthy controls. The results of our study support the antioxidant properties of azithromycin in rosacea.

Abstract Online

Related Articles:

focus on macrolides (biaxin, zithromax, dynabac, rulid, surlid)

David Pascoe — Thu, 28 Sep 2006 03:07:00 +0000

Macrolide Antibiotics offer alternative treatment options to the well known tetracycline antibiotics. In recent years good studies have shown that some of these macrolides are safe and effective in treating rosacea.

Commonly prescribed Macrolides include: erythromycin, azithromycin (Zithromax), clarithromycin (Biaxin), dirithromycin (Dynabac), roxithromycin (Rulid, Surlid)

Here is a brief introduction from Linda Sy’s `Skin411 Digest January 2005‘, Summaries and commentaries from recent dermatologic journals: Rosacea Therapy. Medical editor: Margaret S. Choa M.D.

ORAL MEDICATIONS

2. Macrolides – Oral erythromycin is given to rosacea patients when there are contraindications such as allergy, intolerance or resistance to tetracyclines and in pregnancy, lactation and patients younger than 12 years of age. Erythromycin is in pregnancy category B.

The second-generation macrolides, clarithromycin and azithromycin, have been found in recent studies to be effective in reducing erythema and rosacea papules/pustules. Benefits of second-generation macrolides are improved bioavailability and lack of gastrointestinal side effects in comparison with erythromycin.

The following paper gives some background to the use of macrolides and disease such as acne, rosacea and blepharitis.

Use of macrolides and tetracyclines for chronic inflammatory diseases. Ann Pharmacother. 2005 Jan;39(1):86-94. Epub 2004 Nov 23

OBJECTIVE: To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions.

DATA SOURCES: Searches of MEDLINE (1966-March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis.

STUDY SELECTION AND DATA EXTRACTION: Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based.

DATA SYNTHESIS: Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea.

CONCLUSIONS: The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.

A follow-on the the above article is a question and answer article that gives some useful high level comments ; For Our Patients (PDF).

Macrolides and Tetracyclines for Chronic Inflammatory Diseases

What diseases are macrolides and tetracyclines used for?

Macrolides (for example, erythromycin, clindamycin) and tetracyclines are antibiotics used to treat infections. They are also increasing being studied or used for chronic conditions such as acne, rosacea (a skin disorder that causes flushing of the face, neck and upper chest), blepharitis (inflammation of the eyelids), periodontitis (inflammation of the gums), rheumatoid arthritis, coronary artery disease, and cystic fibrosis. These drugs have anti-inflammatory properties, as well as the ability to inhibit or kill pathogens that may cause these diseases.

Why is there a concern about these drugs in the treatment of chronic inflammatory diseases?

Doxycycline and the newer macrolides are now recommended for the treatment of some types of pneumonia. Overuse of these antibiotics may decrease their effectiveness against respiratory pathogens that cause short-term illnesses, such as pneumonia.

Which antibiotics should be chosen for chronic inflammatory diseases?

Antibiotics are often prescribed for months or even years for acne. Researchers recommend low-dose doxycycline for extended time periods. Current recommendations for rosacea include long-term doxycycline, minocycline, tetracycline, or erythromycin. However, no major clinical trials have been performed to assess their effectiveness.

The American Academy of Ophthalmology recommends the chronic use of either doxycycline or tetracycline for the management of blepharitis.

Periodontitis can be treated for long periods with low doses of doxycycline. Larger clinical trials are needed to confirm the role of macrolides in periodontitis.

Azithromycin, a macrolide, has been used in patients with cystic fibrosis because of its antibacterial and antiinflammatory properties. Patients receiving this drug maintain better lung function, require fewer courses of intravenous antibiotics, and have improved quality of life. However, there are no data demonstrating a stronger survival benefit in patients who have taken macrolides.

Results from published clinical trials do not support the use of macrolides or other antibiotics for the prevention of a repeat heart attack or stroke. Of note, two trials are continuing to study the role of macrolides in the prevention of cardiovascular disease. For patients suffering from rheumatoid arthritis, it appears that minocycline has some effect on the progression of the disease. However, measures of improvement were often difficult to measure with certainty. Further studies are needed to better define the role of minocycline in the treatment of this disease.

How serious is the resistance to antibiotics becoming?

Resistance to one or more antibiotics increased from 35% in 1991 to 56% in 2000. Resistance to erythromycin, clindamycin, and tetracycline approximately doubled over this period. Resistance to the macrolides is increasing and may have reached rates up to 43%.

What approaches should be followed to preserve the effectiveness of antibiotics against acute infectious diseases?

Alternative antiinflammatory medications should be used for chronic inflammatory conditions whenever possible. For instance, high-dose ibuprofen and oral corticosteroids may be beneficial for patients with cystic fibrosis. Clinical trials comparing the effectiveness of antiinflammatory agents with antibiotics should be performed.

Following are links to more studies relating to the use of systemic and topical antibiotics to treat rosacea.

Azithromycin similar to oxytetracycline (terramycin)

David Pascoe — Sun, 05 Mar 2006 15:02:00 +0000

Acne rosacea: An open comparative trial of azithromycin versus oxytetracycline therapy: Study of 50 patients

Bakar Bouadjar, PhD, CHU of BEO, Algiers, Algeria

Background: Azithromycin has been used successfully to treat acne vulgaris and its use for the treatment of rosacea has been evaluated only once in an open study.

Objectives: The goal of the study was to compare the efficacy and safety of oral oxytetracycline and azithromycin in the treatment of patients with acne rosacea.

Patients and methods: We proposed an open comparative study of azithromycin versus oxytetracycline in 50 adults with acne rosacea. Inclusion criteria were as follows: (1) patients with rosacea characterized by persistent symmetrical erythema affecting the cheeks and with at least 10 inflammatory papules or pustules; (2) patients with no treatment for rosacea 1 month prior to starting azithromycin or oxytetracycline. This treatment included topical metronidazole, topical corticosteroids or antibiotics and systemic corticosteroids or antibiotics. Exclusion criteria were as follows: Patients with significant concomitant dermatologic disorders, a presence of other conditions that could affect study results. A single dose of 250 mg of azithromycin was taken 3 times a week during 4 weeks in one group of 25 patients and 250 mg of oxytetracycline was taken 4 times a day during 4 weeks in the second group of 25 patients. The clinical response and side effects was evaluated once a week. The investigator performed a count of inflammatory lesions (papules and pustules) at baseline (week 0) and at weeks 1, 2, 3, and 4. Signs and symptoms (erythema, telangiectasia, dryness, itching, burning) will be assessed by means of a 4-point scale. Throughout the study, the same investigator will make all assessments. Patients will assess their own disease severity: signs and symptoms at week 0, 1, 2, 3, 4. Statistical analysis was done by means of chi-square tests, paired tests, and analysis of variance.

Results: Good to excellent improvement in the two groups was seen. There was no significant difference in the two groups in terms of reduction of the number of inflammatory lesions and in the reduction of symptoms. Eight patients in the oxytetracycline group showed secondary effects (ie, hyperpigmentation, nausea, and abdominal pain).

Conclusion: Our results show that azithromycin is a safe and effective treatment in acne rosacea with few side effects and good compliance and suggest the need for further investigation with a clinical trial that will compare the long-termefficacy and tolerability.

Author disclosure: Nothing disclosed at press time. Commercial support: None.

Poster Discussion Session P139, American Academy of Dermatology, 64th Annual Meeting, March 3-7 2006, San Francisco.

Supplement to Journal of The American Academy of Dermatology, March 2006, Volume 54, Number 3.

JAAD Poster Abstracts Online

Rosacea News: topical azithromycin same as clarithromycin
Rosacea News: pulse dosing with azithromycin
Rosacea News: azithromycin and rosacea
Rosacea News: treating rosacea with azithromycin

is macrolide antibiotic resistance a problem ?

David Pascoe — Wed, 28 Dec 2005 06:43:00 +0000

Macrolide antibiotics are an alternative to tetracycline antibiotics. Macrolides tend to be more expensive and there is less clinical history compared to tetracyclines. Macrolides inhibit bacterial protein synthesis and their association with leukocytes sees them transported into the site of an infection. As with any prescription drug the potential benefit and risk need to be assessed.

What Is the Clinical Impact of Macrolide Resistance?

Current Infectious Disease Reports 2004, 6:7-12, Current Science, Inc. ISSN 1523-3847, John R. Lonks, MD

Respiratory tract infections are treated empirically. Treatment is based on the likely pathogens and their antibiotic susceptibility. The most common respiratory tract pathogen is Streptococcus pneumoniae. In the United States, approximately 25% to 30% of S. pneumoniae are resistant to erythromycin and other macrolides. There are two mechanisms of resistance: ribosomal methylation that causes high-level resistance, and an efflux pump that causes low-level resistance. Macrolides are ineffective in animal models that use pneumococcal isolates with the methylase- or efflux-mediated resistance mechanisms. There are many case reports that describe clinical failure and isolation of a macrolide-resistant pneumococcus while a patient receives macrolide treatment. Two recent studies that included macrolide-susceptible and macrolide-resistant pneumococci showed that breakthrough bacteremia in patients receiving macrolide treatment occurred only with macrolide-resistant isolates. Study of bacteremic disease ensures the pathogenic role of the pneumococcus; however, it underestimates the true clinical impact of macrolide resistance.

Conclusion: Macrolide resistance among S. pneumoniae is increasing. In some areas of the United States, one of three S. pneumoniae are macrolide-resistant. Animal model data show the loss of efficacy of macrolide antibiotics when animals are infected with macrolide-resistant pneumococci, including those with the efflux pump (mef gene). Bacteriologic and clinical failure occurs when patients with otitis media caused by a macrolide-resistant pneumococcus are treated with a macrolide. There are many case reports of patients failing macrolide treatment who have a macrolide-resistant pneumococcus isolated from normally sterile body fluids (including blood) while receiving a macrolide. Recent studies analyzing macrolide-susceptible and macrolide-resistant pneumococcal bacteremias show that treatment failure with breakthrough bacteremia was found only when the isolate was macrolide-resistant, including those with the M phenotype (efflux pump). Study of bacteremic disease ensures the pathogenic role of the pneumococcal isolate. However, by examining only bacteremic pneumococcal disease, the true impact of treatment failures caused by macrolide resistance is underestimated.

The clinical significance of macrolide-resistant Streptococcus pneumoniae: it’s all relative.

Clin Infect Dis, 2004 Jan 1;38(1):99-103.

Nuermberger E, Bishai WR. Center for Tuberculosis Research, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231-1001, USA.

Macrolides are currently recommended as first-line agents for the empirical treatment of community-acquired pneumonia. Heavy use of these agents for a variety of indications has resulted in an increasing incidence of macrolide resistance among pneumococcal isolates. Although several case reports and small case series have suggested that in vitro macrolide resistance is associated with treatment failure in cases of pneumococcal pneumonia, other observational data suggest that drug susceptibility testing may not correlate with treatment failure. In this article, we review current information on the mechanisms of macrolide resistance and the pharmacodynamics of macrolide therapy, together with efficacy data from animal models and clinical observations, to begin to gauge the clinical significance of macrolide resistance in Streptococcus pneumoniae. Areas for further investigation are highlighted.

Rosacea News: macrolides and inflammatory pathways
Rosacea News: azithromycin and rosacea
Rosacea News: treating rosacea with azithromycin
Rosacea News: topical azithromycin same as clarithromycin
Rosacea News: pulse dosing with azithromycin
Rosacea News: biaxin (clarithromycin) vs. vibramycin (doxycycline)
Rosacea News: treating rosacea with clarithromycin (biaxin)
Rosacea News: focus on macrolides (biaxin, zithromax, dynabac, rulid, surlid)

treating rosacea with clarithromycin (biaxin)

David Pascoe — Thu, 22 Dec 2005 01:45:00 +0000

Clarithromycin: a new perspective in rosacea treatment

International Journal of Dermatology, Volume 37 Issue 5 Page 347 – May 1998, Claudio Torresani MD.

Biaxin (Clarithromycin) is a recently synthesized macrolide antibiotic that has shown anti-inflammatory actions. In his 1998 paper Clarithromycin: a new perspective in rosacea treatment, renowned rosacea researcer Dr. Claudio Torresani concludes that “Clarithromycin can be considered to be a drug of primary importance in the treatment of rosacea”.

His study of clarithromycin and rosacea started in 1992 when a patient with follicultis of the legs had unexpected improvement with her rosacea symptoms when treated with biaxin. Further trials compared clarithromycin and doxycycline. Biaxin was shown to result in more consistent improvement compared to the doxycycline (vibramycin). (The dosages used in the trial were: clarithromycin 250mg twice daily for 4 weeks, followed by once daily for the following 4 weeks. For doxycycline: 100mg twice daily for 4 weeks and once daily for the following 4 weeks.)

It was shown that 6 weeks of biaxin was exquivalent to 8 weeks of vibramycin treatment. A followup study at 3 years showed that clarithromycin patients had able to reduce their treatment to an average of 10.2 weeks a year compared to 14.6 weeks for doxycycline.

The side effects were also pleasing. The side effects in both studies were “only occasional and very slight”. Dr. Torresani contrasts these mild side effects with tetracyclines and metronidazole, saying that clarithromycin “may be considered to be an extremely safe therapy”.

The final chapter discusses the possible pharmacologic action of this particular macrolide antibiotic. There is some discussion of helicobacter pylori but no conclusions are drawn.

Conclusions: Clarithromycin can be considered to be a drug of primary importance in the treatment of rosacea, and the cost of therapy is rewarded by the practical absense of side-effects and by the smaller doses on fewer overall days of treatment. We still do not understand exactly how the drug works, but considering its proven efficacy in rosacea treatment, it may be hoped that future studies will discover its hidden secrets.

PubMed Extract
Abstract Online (Full Paper is available from the Author.)
Rosacea News: topical azithromycin same as clarithromycin
Rosacea News: azithromycin and rosacea
Rosacea News: treating rosacea with azithromycin
Rosacea News: pulse dosing with azithromycin
Rosacea News: macrolides and inflammatory pathways
Rosacea News: biaxin (clarithromycin) vs. vibramycin (doxycycline)
Rosacea News: focus on macrolides (biaxin, zithromax, dynabac, rulid, surlid)
Rosacea News: is macrolide antibiotic resistance a problem ?

biaxin (clarithromycin) vs. vibramycin (doxycycline)

David Pascoe — Tue, 20 Dec 2005 02:50:00 +0000

Clarithromycin versus doxycycline in the treatment of rosacea.

International Journal of Dermatology, 1997 Dec;36(12):942-6. Torresani C, Pavesi A, Manara GC, Department of Dermatology, Parma University, Italy.

Forty patients with rosacea were entered into a study comparing clarithromycin with doxycycline in the systemic treatment of mild and severe rosacea.

Results: At the end of the treatment, the overall results provided evidence for a hight clarithromycin efficacy profile in comparison with doxycycline.

Discussion: The etiology and pathogenesis of rosacea are still unknown. The systemic drugs first used in the treatment of rosacea were tetracyclines. This was followed by the introduction of metronidazole. Both therapies achieve significant improvements of dermatosis in 80% to 90% of cases, and no statistically significant differences were observed between them.

The pharmacologic mechanisms of action of both metronidazole and tetracyclines have been widely investigated. The therapeutic activity of tetracyclines seems to be related to their anti-inflammatory efficacy.

Clarithromycin, a recently synthesized macrolide, has been proven to be able to penetrate in phagocytes in vitro. The present study reveals that clarithromycin is a powerful tool in the treatment of rosacea. It yields improvements which are significantly more consistent when compared with those obtained with doxycycline. In contrast with tetracyclines and metronidazole, clarithromycin is a very safe therapy inducing only occasional and slight side effects. This significantly increases patient compliance and is of particular interest when considering the long-term therapy required. The mechanism of action of the drug in dermatosis has not yet been established. It is conceivable that clarithromycin also has anti-inflammatory capabilities.

PubMed Extract (Full Article available from the Author.)

pulse dosing with azithromycin

David Pascoe — Fri, 09 Dec 2005 05:51:00 +0000

There doesn’t seem to be many references to what pulse-dosing means with respect to antibiotics. I take this paper to say that triallists were treated with 500mg once a day for 3 days and then took a break for 4 days, repeating the same the following week.

Pulse therapy with azithromycin in acne rosacea and peri-oral dermatitis: an open study.

Azithromycin Appears Effective for Rosacea and Peri-Oral Dermatitis: Presented at AAD

Doctor’s Guide

By Ed Susman, NEW ORLEANS, LA — February 21, 2005 — An eight-week course of antibiotic therapy with azithromycin appears to substantially clear outbreaks of acne rosacea and peri-oral dermatitis, Italian researchers reported on February 20th at the 63rd annual meeting of the American Academy of Dermatology.

“We need something new for our patients with these conditions,” said Ruggero Caputo, MD, chairman of the department of dermatology at the University of Milan, Italy, in discussing his poster at a moderated presentation session.

Dr. Caputo and colleagues recruited 20 men and women with acne rosacea and 20 women with peri-oral dermatitis and treated them with a course of oral azithromycin 500 mg a day for three days. They repeated the “pulse therapy” for at least four weeks and up to eight weeks.

“All the patients improved,” said Dr. Caputo, but marked improvement according to standard scales of improvement ; was observed in 13 patients with papulopustular rosacea after four weeks. After 6 weeks, 15 of the patients had achieved a marked improvement, and that increased to 18 patients, 90% of the group after 8 weeks of treatment.

A similar improvement was seen in the women with peri-oral dermatitis. A marked improvement was demonstrated in 12 patients after 4 weeks, in 14 patients after 6 weeks, and in 17 patients, 85% of the total after 8 weeks.

“Data at the end of the study are suggestive for a clear therapeutic role of azithromycin in papulopustular rosacea and peri-oral dermatitis like [that already] demonstrated in papulopustular acne,” Dr. Caputo said.

He said the trial also shows:

Azithromycin has anti-inflammatory properties that could be useful in the treatment of inflammatory dermatoses of the face.
Pulse therapy regimen improves the compliance of patients.
Azithromycin is well-tolerated by patients. Two people experienced gastralgia, but neither had to suspend use of the drug.
Azithromycin is not phototoxic; therefore, it can be prescribed with safety at all times of the year.

“The results of this study were a bit surprising to me,” said session moderator Guy Webster, MD, professor and vice chairman of dermatology at Jefferson Medical College, in Philadelphia, Pennsylvania. He said he did not expect that azithromycin would show as much anti-inflammatory effect as other more commonly used anti-acne antibiotics, such as doxycycline.

But he said the results may have been surprising because the nature of rosacea continues to be puzzling.

Extract Online
Rosacea News: azithromycin and rosacea
Rosacea News: treating rosacea with azithromycin
Rosacea News: topical azithromycin same as clarithromycin