Combining Azithromycin with Protopic (tacrolimus) topical

Written by on May 27, 2008 in macrolides, Rosacea Topicals with 1 Comment


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.

See also: FDA Protopic Ointment Information, full Protopic Prescribing Information.

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Read more about: macrolides, Rosacea Topicals

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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1 Reader Comment

  1. Azeem says:

    Good article

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