The AHRQ report reviewed 11 placebo-controlled trials of oral antibiotics82-92 and two others were located by searches9394 (see Web Table 13.4). All but two RCTs investigated tetracycline; one evaluated minocycline83 and one doxycycline.95 All were double blind and most included patients with moderate-to-severe acne. Only three provided data at 12 weeks or more85,88,89 and only three included more than 50 patients in each arm.89,91,93 Tetracycline at total daily doses of 500 mg and 1 g was consistently superior to placebo in terms of overall grade and reduction in IL. The only data on NIL was from the doxycycline RCT,95 which indicated comparable efficacy at 4 weeks, but this is to be expected given the delayed onset of activity associated with oral antibiotics.
Nine head-to-head RCTs of the currently used oral antibiotics were included in the AHRQ review96-104 and the Cochrane review located a further nine105-113 (see Web Table 13.5). The majority of the trials had problems with design
What is the role of antibiotics in the management of acne vulgaris?
and execution. No oral antibiotic was demonstrated to be superior to another, although equivalence cannot be conclusively stated as no study was adequately powered to demonstrate it. Percentage reductions in IL were consistently greater than 50% at 12 weeks. Percentage reductions in NIL were more variable, with only two RCTs showing more than 50% reductions at 12 weeks.110,113 The results consistently showed an improvement in 70-90% of individuals at 12 weeks.
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