rifampin and Hidradenitis-Suppurativa

Can therapy with clindamycin and rifampicin be safely continued long term beyond the recommended 10-week course?. Clindamycin and rifampicin are used in combination to treat hidradenitis suppurativa (HS). There is no data on the efficacy and safety of clindamycin/rifampicin combination therapy for HS beyond 10 weeks.. We identified the following major concerns that still lack a proper evidenced-based analysis: for rifampicin, drug-induced liver injury, interstitial nephritis, drug interaction and hepatic p450 3A4 enzyme induction; for clindamycin, the concern was community-acquired Clostridium difficile infection (CA-CDI); and experience with long-term treatment. Data sources were used as appropriate to answer the question. Systematic searches were used to assess the risk of CA-CDI and experience with long-term treatment with clindamycin.. The risk for rifampicin-induced liver injury is highest in the first 6 weeks of treatment, whereas interstitial nephritis is primarily observed during intermittent treatment. Enzyme induction due to rifampicin is usually complete after about 2 weeks of treatment and reduces clindamycin blood levels by about 90%. Three meta-analyses identified antibiotic use as a risk factor for CA-CDI. Two of them assigned the highest risk to clindamycin. None of them stratified by length of treatment. There is extensive experience with rifampicin, primarily for the treatment of tuberculosis. Long-term experience with clindamycin is limited.. The analysed risks associated with a combination of clindamycin and rifampicin for hidradenitis suppurative cluster within the first 10 weeks. Treatment can be continued beyond 10 weeks, if clinically necessary.

Topics: Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Clindamycin; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inducers; Drug Interactions; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Hidradenitis Suppurativa; Humans; Meta-Analysis as Topic; Nephritis, Interstitial; Rifampin; Risk Assessment; Systematic Reviews as Topic; Time Factors

Although the clinical presentation of Hidradenitis Suppurativa (HS) is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacterial specimens as well as biofilm formation in lesional HS skin. Consistent findings of Gram-positive cocci and -rods including Staphylococus aureus, Coagulase-negative staphylococci (CoNS) and Corynebacterium species (spp) in deep tissue samples have been demonstrated in HS. Although efficacy of antibiotics, i.e., rifampicin, clindamycin or tetracycline may support a microbial role in disease pathogenesis, the most often isolated bacterial specimens are commensal bacteria (CoNS).

Topics: Anti-Bacterial Agents; Biofilms; Clindamycin; Corynebacterium Infections; Hidradenitis Suppurativa; Humans; Rifampin; Skin; Staphylococcal Skin Infections; Staphylococcus aureus; Staphylococcus epidermidis; Tetracycline

Although hidradenitis suppurativa (HS) is not primarily an infectious disease, antibiotics are widely used to treat HS. Recent microbiological data show that HS suppurating lesions are associated with a polymorphous anaerobic flora, including actinomycetes and milleri group streptococci, and can therefore be considered as polymicrobial soft tissue and skin infections. Analysis of the literature provides little information on the efficacy of antibiotics in HS but suggests a beneficial effect of certain antimicrobial treatments, depending on the clinical severity of the disease. Patients must be informed and should agree with the treatment strategy before starting antibiotic treatments.

Topics: Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Clindamycin; Drug Therapy, Combination; Ertapenem; Fluoroquinolones; Hidradenitis Suppurativa; Humans; Imipenem; Maintenance Chemotherapy; Metronidazole; Moxifloxacin; Remission Induction; Rifampin

Combinations of rifampin and clindamycin or rifampin, metronidazole, and moxifloxcin have been reported as effective treatments for hidradenitis suppurativa (HS) Hurley Stage 1 and Hurley Stage 2.  Clinical trials suggest that for stage 1 and mild stage 2 HS, clindamycin 300 mg twice daily and rifampin 300 mg twice daily for 10 weeks can substantially abate HS in ~80% of cases and remit HS in ~50% of cases.  Another study notes use of rifampin-moxifloxacin-metronidazole given for 6 weeks, dosed as rifampin (10 mg/kg once daily), moxifloxacin (400 mg daily), and metronidazole (500 mg thrice daily) with the metronidazole stopped at week 6.   Rifampin and moxifloxacin were continued if the HS improved and side effects did not occur.  Using this triple antibiotic regimen remission occurred in 100% Hurley Stage 1, 80% Hurly Stage 2, and 16.7 % of Hurley Stage 3 HS.   The author typically gives HS clindamycin 300 mg and rifampin 300 mg, each twice daily, for 10 weeks and assesses if remission has occurred.  If the patient has not achieved remission the author continues the regimen as long as the patient's clinical status continues to improve without side effects.  The reasons why rifampin is so effective against HS have not been fully defined and might involve rifampin's (1) antibacterial effects (2) effects on bacterial biofilms (3) anti-inflammatory effects (4) effects against granulomas (5) and immunomodulatory effects on neutrophils.  It is notable that rifampin, although not first line, is an effective treatment for Clostridium difficile, a pathogen that arises during treatment with clindamycin.  Thus, rifampin enhances safety when rifampin and clindamycin are combined for the treatment of HS.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Biofilms; Clindamycin; Corynebacterium Infections; Drug Therapy, Combination; Granuloma; Hidradenitis Suppurativa; Humans; Immunologic Factors; Neutrophils; Rifampin; Staphylococcal Infections; Streptococcal Infections

To conduct a systematic review of the effectiveness of various modalities to treat hidradenitis suppurativa (HS) and to establish recommendations on its appropriate management.. MEDLINE, Cochrane, and PubMed databases.. English-language prospective, retrospective, and case studies describing at least 4 patients with HS.. Data quality and validity were addressed by multiple reviewers using independent extraction.. Studies were categorized as treatments using antibiotics, biological agents, laser surgery, excisional surgery, or miscellaneous modalities. Of 62 publications included in the review, 4 studies met criteria to be assigned the highest grade for quality of evidence.. Shown to be effective treatments for HS were a clindamycin-rifampin combination regimen, a course of infliximab, monthly Nd:YAG laser sessions, and surgical excision and primary closure with a gentamicin sulfate-collagen sponge. Most therapies used to treat HS were supported by limited or weak scientific evidence. A treatment approach is presented based on the evidence and on clinical experience at the Follicular Disorders Clinic, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. This review emphasizes the need for large randomized controlled trials to evaluate treatment options for HS.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal; Biological Products; Clindamycin; Dermatologic Agents; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Infliximab; Lasers, Solid-State; Rifampin

In the present single-center retrospective study, we investigated our data to evaluate the efficacy of the classic antibiotic combination (rifampicin and clindamycin) compared to adalimumab treatment in patients affected by moderate-to-severe hidradenitis suppurativa. Disease severity and quality of life were registered using the modified Sartorious score and Hidradisk, respectively. Data were collected before starting treatment (T0) and after ten weeks of therapy (T10). The Mann-Whitney test was used to calculate statistical differences between baseline and week 10. P values less than 0.05 were considered to be statistically significant. A spearman test was used to evaluate the correlation among the parameters under study. Thirty patients (20 females, 10 males; mean age, 23.73 ± 4.57) were given the antibiotics: instead of starting the treatment by combining the two antibiotics, we recommend patients to start the therapy taking only rifampicin 300 mg twice a day for 7 days, and after the first week, to add clindamycin at a dose of 300 mg twice a day. The mean modified Sartorius Score before starting treatment was 68.8 while the value at week 10 was 57.8 (P equals 0.0052). The mean Hidradisk value before starting treatment was 74,73 while the value at week 10 was 62 (P equals 0.0095). Ten patients (10/30) achieved the HiSCR. On the other hand, thirty subjects (22 females, 8 males; mean age, 26.2±7.25) were treated with subcutaneous injections of adalimumab (160 mg at baseline, 80 mg at week 2, 40 mg at week 4, and 40 mg weekly thereafter). The mean modified Sartorius Score before starting treatment was 74.93 while the value at week 10 was 39.86 (P less than 0.0001). The mean Hidradisk value before starting treatment was 77.73 while the value at week 10 decreased to 51.86 (P less than 0.0001). Eighteen patients (18/30) achieved the HiSCR.\ \ J Drugs Dermatol. 2019;18(5):437-438.

Topics: Adalimumab; Administration, Oral; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Clindamycin; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Injections, Subcutaneous; Male; Quality of Life; Retrospective Studies; Rifampin; Severity of Illness Index; Treatment Outcome; Young Adult

Hyperbaric oxygen therapy (HBOT) appears to enhance wound healing, increase bactericidal activity, and act synergistically with a number of antibiotics. The aim of this study was to evaluate the efficacy of HBOT as an adjunctive therapy in patients with hidradenitis suppurativa (HS) treated with a combination of systemic rifampicin and clindamycin. The study was a prospective, single-center, single-dose, open-label, randomized controlled clinical study of HBOT in patients with moderate to severe HS. Efficacy was measured by modified Sartorius score (SS), HS Severity Index (HSSI), Dermatology Life Quality Index (DLQI), and a visual analog scale (VAS) before treatment and after the completion of 4 and 10 weeks of treatment. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were also measured. Forty-three patients were enrolled in the study. More patients in the HBOT than in the control group showed a decrease of ≥50% from baseline parameters at week 10 for SS (100%), HSSI (100%), DLQI (95.5%), VAS (100%), ESR (100%), and CRP (72.7%). Clinically and statistically significant improvements from baseline were observed at 4 and 10 weeks in HSSI (P = 0.009 at both), SS (P = 0.021 at both), and DLQI (P = 0.044 at week 4, P = 0.009 at week 10). Adjunctive HBOT was considered to be effective in significantly improving antibiotic treatment of HS. The treatment was well tolerated, and no unexpected safety issues were identified.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Clindamycin; Combined Modality Therapy; Erythrocyte Indices; Female; Hidradenitis Suppurativa; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Pain Measurement; Prospective Studies; Quality of Life; Rifampin; Severity of Illness Index; Young Adult

Topics: Anti-Bacterial Agents; Canada; Clindamycin; Hidradenitis Suppurativa; Humans; North American People; Rifampin; United States

Topics: Anti-Bacterial Agents; Clindamycin; Hidradenitis Suppurativa; Humans; Prevalence; Rifampin

Topics: Anti-Bacterial Agents; Clindamycin; Hidradenitis Suppurativa; Humans; Prevalence; Rifampin

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of the hair follicles leading to painful lesions, associated with increased levels of pro-inflammatory cytokines. Numerous guidelines recommend antibiotics like clindamycin and rifampicin in combination, as first-line systemic therapy in moderate-to-severe forms of inflammation. HS has been proposed to be mainly an auto-inflammatory disease associated with but not initially provoked by bacteria. Therefore, it has to be assumed that the pro-inflammatory milieu previously observed in HS skin is not solely dampened by the bacteriostatic inhibition of DNA-dependent RNA polymerase. To further clarify the mechanism of anti-inflammatory effects of rifampicin, ex vivo explants of lesional HS from 8 HS patients were treated with rifampicin, and its effect on cytokine production, immune cells as well as the expression of Toll-like receptor 2 (TLR2) were investigated. Analysis of cell culture medium of rifampicin-treated HS explants revealed an anti-inflammatory effect of rifampicin that significantly inhibiting interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumour necrosis factor (TNF)-α production. Immunohistochemistry of the rifampicin-treated explants suggested a tendency for it to reduce the expression of TLR2 while not affecting the number of immune cells.

Topics: Anti-Inflammatory Agents; Clindamycin; Hidradenitis Suppurativa; Humans; Rifampin; Toll-Like Receptor 2

Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory nodules and abscesses. The pathogenic role of bacteria is not fully understood. As the diagnosis is usually delayed, patients are often treated with several lines of antibiotics in a nonstandardized fashion. The aim of the study was to investigate and compare the bacteriology of active HS lesions in patients treated or not treated with antibiotics in the community setting before referral to a dedicated HS clinic.. Purulent skin lesions of patients with HS referred to the HS Clinic of Rabin Medical Center in 2009-2020 were cultured. Data were collected from the patients' medical files and microbiology reports. The correlation between the location of the skin lesion and the bacteriologic profile was analyzed, and the effects of previous antibiotic treatment on the bacteriologic profile of the lesions and susceptibility patterns of the cultured bacteria were evaluated.. Pus (or tissue) from inflammatory lesions of 97 patients with HS was cultured. Mean (SD) patient age was 39.5 (13.0) years, and mean delay in diagnosis was 7.3 (8.3) years. Most patients (57.7%) had dominant involvement of one location, with the most active lesions concentrated in the genitalia, gluteal/perineal area, and axilla. Enterobacterales species were the most frequent isolates detected in all locations except the face and scalp. Seventy-eight patients (80.4%) had been treated in the community setting prior to referral with a median (range) of 2 (1-8) lines of antibiotics. The most commonly prescribed antibiotics were amoxicillin/clavulanate (22.0%), doxycycline/minocycline (16.8%), clindamycin (16.2%; monotherapy 8.1%, clindamycin with rifampicin 8.1%), and cephalexin (13.9%). Compared to the previously untreated patients, cultures of lesions from the previously treated patients yielded a higher percentage of gram-negative Enterobacterales (the most common isolates in this group) (31.3% vs. 10.3%) and a significantly higher median number of isolates per culture (2 vs. 1, p < 0.0001). Gram-positive bacteria, usually considered contaminants (mainly coagulase-negative staphylococci) accounted for 31.0% of the isolates in the previously treated group. Susceptibility testing for the entire cohort revealed 100% bacterial sensitivity to ciprofloxacin. Staphylococcus spp. were 100% sensitive to rifampicin. Both gram-positive and gram-negative bacteria had high sensitivity to trimethoprim and sulfamethoxazole.. Nonstandardized antibiotic treatment of HS in the community setting can skew the microbiology of skin lesions toward gram-negative bacteria. Therefore, treatment with trimethoprim and sulfamethoxazole or ciprofloxacin, either alone or combined with rifampicin, may be considered.

Topics: Adult; Anti-Bacterial Agents; Bacteriology; Ciprofloxacin; Clindamycin; Gram-Negative Bacteria; Gram-Positive Bacteria; Hidradenitis Suppurativa; Humans; Referral and Consultation; Rifampin; Sulfamethoxazole; Trimethoprim

Prolonged systemic antibiotic treatment is often a part of management of hidradenitis suppurativa (HS). Although biologic therapies are now available, the patient's treatment journey leading to biologic therapy is unclear.. To examine treatment patterns and duration of systemic treatment use in patients with HS preceding biologic therapy.. We identified all patients with HS receiving treatment with biologics in the Danish National Patient Registry from 2010 to 2018 and extracted their entire prescription history of specific systemic treatments from the Danish National Prescription Registry since its inception in 1995. The patients' treatment journeys are graphically displayed through Sankey diagrams and box plots generated to show temporal distributions. Descriptive patient characteristics were presented as frequencies with percentages for categorical variables and as means with SDs or medians with interquartile ranges (IQRs) for continuous variables.. A total of 225 patients with HS were included. Patients had most frequently been treated with penicillin (n = 214; 95·1%), dicloxacillin (n = 194; 86·2%), tetracycline (n = 145; 64·4%) and rifampicin/clindamycin (n = 111; 49·3%), as well as the retinoids isotretinoin and acitretin, and dapsone. Prior to biologic therapy, patients received a mean of 4·0 (SD 1·3) different systemic therapies, across a mean of 16·9 (SD 11·3) different treatment series. The mean time from first systemic therapy until biologic therapy was initiated was 15·3 (SD 5·1) years [8·2 (SD 5·9) years when excluding penicillin and dicloxacillin].. Patients with HS who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS. Delay in the initiation of biologic therapy may represent a missed opportunity to prevent disease progression. What is already known about this topic? The treatment journey leading to biologic therapy in patients with HS has not previously been investigated. What does this study add? Our data from 225 patients with HS illustrate that patients who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS.

Topics: Acitretin; Anti-Bacterial Agents; Biological Factors; Biological Products; Clindamycin; Dapsone; Dicloxacillin; Drug Utilization; Hidradenitis Suppurativa; Humans; Isotretinoin; Rifampin; Tetracyclines

Antibiotic therapy remains the first-line treatment for hidradenitis suppurativa (HS). However, literature data on its comparative clinical efficacy and safety are limited.. To investigate the efficacy of tetracycline (lymecycline 300 mg daily) vs. the combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily) by evaluating and comparing the clinical response at the end of antibiotic treatment (10 weeks).. The study retrospectively analysed 52 patients divided in two groups of 26 patients: Group A received lymecycline and Group B received clindamycin plus rifampicin for 10 weeks. Subjects had mild, moderate and severe HS. The clinical and ultrasonography extent of disease was measured by the Hurley Score, Sonographic Score of Hidradenitis Suppurativa, International Hidradenitis Suppurativa Severity Score System (IHS4), pain visual analogue scale (pain VAS) and Dermatology Life Quality Index (DLQI). The primary outcome was the clinical response at the end of the antibiotic treatment period, according to the Hidradenitis Suppurativa Clinical Response measure.. Both groups showed a significant improvement in IHS4, pain VAS and DLQI from baseline, but this was more marked in Group A. Reductions in nodule counts were similar between the two groups, whereas the number of abscesses and draining tunnels decreased more in Group B. Disease-free survival was similar between the two groups.. Lymecycline monotherapy and clindamycin plus rifampicin combination are both effective treatments for patients with moderate-severe HS. Nodular-type HS seems to respond better to lymecycline, whereas the abscess/tunnel type seems to respond better to clindamycin plus rifampicin.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Clindamycin; Disease-Free Survival; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Lymecycline; Male; Middle Aged; Pain Measurement; Retrospective Studies; Rifampin; Severity of Illness Index; Treatment Outcome; Ultrasonography; Young Adult

Topics: Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Prospective Studies; Rifampin

Hidradenitis suppurativa is a chronic and debilitating inflammatory condition related to a permanent obstruction of the pilosebaceous units. Until nowadays, therapeutic options are unsatisfactory. Here, we propose nanostructured lipid carriers (NLC) entrapping an association of clindamycin phosphate (CDM) and rifampicin (RIF) as a topical alternative for the treatment of the disease. Chemical compatibility between the drugs was demonstrated using thermal analysis combined with ATR-FTIR and X-ray powder diffraction assays. Nanocarriers' diameter was narrowly distributed (polydispersity index = 0.2) around 400 ± 14 nm, they possess a negative surface charge (-48.9 ± 0.7 mV) and high drug entrapment efficiencies (80.2 ± 0.4 % and 93.4 ± 0.7 % for CDM and RIF, respectively). The formulation proved to be safe for the topical application, as it was non-irritant on both HET-CAM and reconstructed human epidermis (RHE) assays. Spin-label EPR indicated an NLC affinity for the lipidic domains of stratum corneum, which could benefit the targeting of the sebaceous units. Indeed, when applied on the skin in vitro, even when mimicking the sebaceous condition, NLC accumulated into the hair follicles openings, not altering the amount of accumulated CDM and significantly increasing by 12-fold the uptake of RIF in these structures. In conclusion, developed NLC formulation incorporating the antibiotics CDM and RIF is a promising strategy for the topical treatment of hidradenitis suppurativa or other infections that may affect the pilosebaceous units.

Topics: Clindamycin; Drug Carriers; Hair Follicle; Hidradenitis Suppurativa; Humans; Lipids; Rifampin; Skin Absorption

Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes.. To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin.. A prospective, international cohort study performed between October 2018 and August 2019.. In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain.. Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline.. This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.

Topics: Adult; Clindamycin; Cohort Studies; Drug Combinations; Europe; Female; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Tetracyclines; Treatment Outcome

Topics: Anti-Bacterial Agents; Child; Clindamycin; Hidradenitis Suppurativa; Humans; Prospective Studies; Rifampin

Topics: Anti-Bacterial Agents; Clindamycin; Hidradenitis Suppurativa; Humans; Retrospective Studies; Rifampin

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Adolescent; Anti-Bacterial Agents; Body Mass Index; Child; Clindamycin; Comorbidity; Cross-Sectional Studies; Dermatologic Surgical Procedures; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Hirsutism; Humans; Male; Obesity; Pilonidal Sinus; Resorcinols; Rifampin; Risk Factors; Severity of Illness Index; Smoking; Tetracycline; Treatment Outcome; Young Adult

Over recent years, the link between obesity, metabolic syndrome and Hidradenitis suppurativa (HS) has been explored. It has been demonstrated that HS patients have a high prevalence of the metabolic syndrome and an increased frequency of insulin resistance. The objective of our study is to estimate the effectiveness of an oral supplementation based on myo-inositol (MI), folic acid and liposomal magnesium (Levigon. Twenty subjects with HS and an impaired glucose metabolism were enrolled. Group A: 10 subjects received for 6 months MI 2000 mg, liposomal magnesium and folic acid associated to topical antibiotic therapy (clindamycin gel 1%), systemic antibiotic therapy (clindamycin 300 mg b.i.d. and rifampicin 600 mg daily for 6 weeks) and a normocaloric diet group B: 10 subjects received topical and systemic antibiotic therapy associated to a normocaloric diet for 6 months.. After 6 months group A patients showed an average reduction of Sartorius Score from 38.3±7.75 to 27.3±13.53 (P value <0.04) while in the control group there was a reduction of the Sartorius from 38.4±7.88 to 31.1±8.02 (P value =0.55). Moreover in group A Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was significantly reduced from 2.43±0.35 to 2.1±0.31 (P<0.01) whereas in group B HOMA-IR did not significantly decrease (2.51±0.65 at T0 at 2.40±0.67 at T1).. Our study underlines the importance of the evaluation of metabolic profile in patients with HS. Moreover, it suggests that the supplementation of MI, folic acid and liposomal magnesium in HS can improve the efficacy of concomitant therapies and the metabolic profile.

Topics: Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Clindamycin; Dietary Supplements; Drug Combinations; Drug Therapy, Combination; Energy Intake; Folic Acid; Glucose Intolerance; Hidradenitis Suppurativa; Humans; Inositol; Insulin Resistance; Liposomes; Magnesium; Metabolic Syndrome; Prevalence; Rifampin; Severity of Illness Index

An aberrant interaction between commensal skin bacteria and the host skin immune system is considered important in the pathogenesis of hidradenitis suppurativa (HS).. In this study, we investigated the antibiotic susceptibility and biofilm-forming capabilities of S. epidermidis strains isolated from HS patients.. Skin biopsies were taken from active HS lesions such as inflammatory nodules and/or sinuses and non-involved skin from 26 patients and cultured under optimal microbiological conditions for 24 h. Planktonic growth, biofilm production, antibiotic susceptibility and biofilm eradication by clindamycin, doxycycline, rifampicin and tetracycline were tested including a laboratory control strain of S. epidermidis for reference.. Staphylococcus epidermidis was cultured in 16 of 26 HS patients (62%). In total 27 different S. epidermidis isolates were identified; 16 (59%) from non-involved skin and 11 (41%) from HS lesions. All bacterial strains showed planktonic growth. Twenty-four of 27 (89%) isolates were strong biofilm producers in vitro. The biofilm-forming capability varied amongst the strains from non-involved skin and lesional skin. Twenty-four strains had an intermediate to resistant antibiotic susceptibility to clindamycin (89%). Rifampicin was the most effective antibiotic at inhibiting planktonic growth and at eradication of biofilm (P < 0.05).. We observed a slight increase in S. epidermidis virulence, characterized by resistance to commonly used antibiotics, increased biofilm production and resistance to biofilm eradication. In particular, the reduced sensitivity to tetracycline and clindamycin, two standard antibiotics in the treatment of HS, is alarming. Rifampicin, also important in HS treatment, showed the greatest efficacy at eradicating the biofilm at low MIC concentrations.

Topics: Anti-Bacterial Agents; Biofilms; Clindamycin; Doxycycline; Drug Resistance, Bacterial; Hidradenitis Suppurativa; Humans; Microbial Sensitivity Tests; Rifampin; Staphylococcus epidermidis; Tetracycline

Topics: Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Rifampin

Topics: Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Rifampin

Antibiotics are recognized as first-line treatments for hidradenitis suppurativa (HS), but the data on their efficacy are limited.. Evaluate the efficacy of oral clindamycin versus that of clindamycin plus rifampicin in patients with HS.. A total of 60 patients with mild-to-moderate-severe HS who were classified according to their International Hidradenitis Suppurativa Severity Score System (IHS4) and Hurley scores, were subdivided into 2 groups of 30 patients each (group A, the members of which received clindamycin plus rifampicin, and group B, the members of which were treated with clindamycin alone) and retrospectively studied. The main objective was to evaluate and compare the clinical and ultrasound responses between the groups after 8 weeks of treatment according to the Hidradenitis Suppurativa Clinical Response measure.. After the treatment, 17 of 30 patients in group A and 19 of 30 in group B met the primary outcome. Both groups showed a similar improvement of IHS4 score, whereas the Dermatology Life Quality Index and pain Visual Analogue Scale scores improved more in group B. In particular, the reductions in nodule and abscess counts were similar between the 2 groups, whereas the number of draining tunnels decreased more in group B. The factors significantly associated with Hidradenitis Suppurativa Clinical Response score were age, body mass index, IHS4 score, and absence of axillary involvement. Disease-free survival was similar between the 2 groups.. The study was not randomized or placebo-controlled.. Clindamycin may be a useful treatment alternative to antibiotic combination regardless of HS clinical stage.

Topics: Adolescent; Adult; Age Factors; Anti-Bacterial Agents; Body Mass Index; Clindamycin; Disease-Free Survival; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Pain; Quality of Life; Retrospective Studies; Rifampin; Severity of Illness Index; Treatment Outcome; Ultrasonography; Young Adult

Topics: Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Rifampin

Topics: Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Rifampin

Topics: Administration, Oral; Adult; Age Factors; Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Male; Medication Adherence; Middle Aged; Retrospective Studies; Rifampin; Smoking

Topics: Anti-Bacterial Agents; Clindamycin; Contraceptives, Oral; Female; Hidradenitis Suppurativa; Humans; Rifampin

Topics: Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Rifampin

Topics: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Child; Clindamycin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Substitution; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Ofloxacin; Retrospective Studies; Rifampin; Treatment Outcome; Young Adult

Topics: Biochemical Phenomena; Hidradenitis Suppurativa; Humans; Mycobacterium tuberculosis; Rifampin; Tuberculosis

We report a case of Clostridium difficile infection in a patient with hidradenitis suppurativa who was taking clindamycin and rifampin. Clostridium difficile infection treatment prompted discontinuation of the medication. Clostridium difficile infection is known to develop after antibiotic treatment, such as clindamycin, but has rarely been associated with anti-tuberculosis agents, such as rifampin. Clinicians should be aware of the risk of Clostridium difficile infection in patients with hidradenitis suppurativa, even in those receiving rifampin.

Topics: Anti-Bacterial Agents; Clindamycin; Clostridioides difficile; Clostridium Infections; Female; Hidradenitis Suppurativa; Humans; Middle Aged; Rifampin

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Clindamycin; Contraindications, Drug; Drug Administration Schedule; Drug Therapy, Combination; Fluoroquinolones; Hidradenitis Suppurativa; Humans; Moxifloxacin; Mycobacterium tuberculosis; Rifampin; Tuberculosis, Multidrug-Resistant

Topics: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Clindamycin; Female; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Rifampin; Treatment Outcome; Young Adult

Limited data exist on the use of systemic antibiotic treatment for hidradenitis supportive (HS).. To investigate the effectiveness, safety and relapse rate of HS treated with a combination of daily oral clindamycin and rifampicin.. This was a prospective, hospital-based study of oral clindamycin 600 mg and rifampicin 600 mg daily for 12 weeks for treatment of HS. Patients were followed up for 1 year to monitor for relapse.. In total, 26 patients with HS received oral clindamycin and rifampicin. Most were overweight or obese (73%), and most were smokers (88%). After 12 weeks, clinical response was noted in 19 patients (73%). Response was associated only with female sex (P = 0.02), and not with body mass index, Hurley stage or lesion location. Eight patients (31%) experienced adverse events. At the 1-year follow-up, there was sustained efficacy in 7 (41%) patients, while 10 (59%) had disease relapse after a mean time of 4.2 months.. Oral clindamycin with oral rifampicin for 12 weeks is an effective and tolerable regimen for HS.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Female; Follow-Up Studies; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Young Adult

Topics: Administration, Oral; Adolescent; Adult; Clindamycin; Female; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Young Adult

A 29-year-old man with painless ulcers on the lumbar and inguinal regions associated with purulent discharge of 1.5 years' duration presented to our outpatient clinic. Dermatological examination revealed palpable nodules, discharging sinuses and scars on the left lumbar, gluteal and inguinal regions. According to the clinical, histopathological, scintigraphy, and magnetic resonance imaging findings as well as mycobacteriological examinations, the patient was diagnosed with Pott's disease with scrofuloderma and psoas abscess. Herein, we present an interesting case of Pott's disease with scrofuloderma and psoas abscess mistreated as hidradenitis suppurativa for a long time.

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Diagnosis, Differential; Diagnostic Errors; Ethambutol; Hidradenitis Suppurativa; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Psoas Abscess; Pyrazinamide; Rifampin; Tuberculosis, Cutaneous; Tuberculosis, Spinal

Antibiotics have been shown to improve hidradenitis suppurativa (HS) patients but complete remission is rare using these treatments.. To assess the efficacy and safety of a combination of oral rifampin, moxifloxacin and metronidazole in long-lasting refractory HS.. We retrospectively studied 28 consecutive HS patients including 6, 10 and 12 Hurley stage 1, 2 and 3 patients, respectively. Complete remission, defined as a clearance of all inflammatory lesions including hypertrophic scars, was the main outcome criterion of the study.. Complete remission was obtained in 16 patients, including 6/6, 8/10 and 2/12 patients with Hurley stage 1, 2 and 3, respectively (p=0.0004). The median duration of treatment to obtain complete remission was 2.4 (range 0.9-6.5) and 3.8 months (range 1.6-7.4) in stage 1 and 2 patients, respectively, and 6.2 and 12 months in the 2 stage 3 patients. Main adverse events of the treatments were gastrointestinal disorders (64% of patients) and vaginal candidiasis (35% of females). Reversible tendinopathy and hepatitis occurred in 4 and 1 patient, respectively.. Complete remission of refractory HS can be obtained using broad-spectrum antibiotics and Hurley staging is a prognostic factor of response to the treatment.

Topics: Adult; Anti-Infective Agents; Antibiotics, Antitubercular; Aza Compounds; Drug Therapy, Combination; Female; Fluoroquinolones; Hidradenitis Suppurativa; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Metronidazole; Middle Aged; Moxifloxacin; Prognosis; Quinolines; Recurrence; Remission Induction; Retrospective Studies; Rifampin; Treatment Outcome; Young Adult

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Clindamycin; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Rifampin

Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne.. To describe the skin lesions of a group of patients with HS.. Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions.. The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, 'worm-eaten scars' and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect.. Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.

Topics: Acne Vulgaris; Adult; Back; Cicatrix; Clindamycin; Dermatologic Agents; Epidermal Cyst; Face; Female; Hidradenitis Suppurativa; Humans; Isotretinoin; Male; Middle Aged; Pilonidal Sinus; Rifampin; Skin Ulcer; Treatment Outcome; Young Adult

Antibiotics are frequently used to treat hidradenitis suppurativa (HS); however, few data on their efficacy are available.. To evaluate the efficacy of a combination of systemic clindamycin (300 mg twice daily) and rifampicin (600 mg daily) in the treatment of patients with severe HS.. Patients (n = 116) who received this combination were studied retrospectively. The main outcome measure was the severity of the disease, assessed by the Sartorius score, before and after 10 weeks of treatment.. The Sartorius score dramatically improved at the end of treatment (median = 29, interquartile range = 14.5, vs. median = 14.5, interquartile range = 11; p < 0.001), as did other parameters of severity as well as the quality of life score. Eight patients (6.9%) stopped the treatment because of side effects.. The combination of clindamycin and rifampicin is effective in the treatment of severe HS.

Topics: Administration, Oral; Clindamycin; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Hidradenitis Suppurativa; Humans; Male; Patient Satisfaction; Quality of Life; Retrospective Studies; Rifampin; Severity of Illness Index; Treatment Outcome

A previous limited study showed promising results of combined oral treatment with rifampicin 600 mg and clindamycin 600 mg for 10 weeks.. To expand and to validate the basis for this therapy, we reviewed the response to different treatment durations.. A retrospective study in 34 patients.. Twenty-eight of 34 patients (82%) experienced at least partial improvement, and 16 (47%) showed a total remission. The maximum effect of treatment appeared within 10 weeks. Following total remission, 8 of 13 (61.5%) patients treated as mentioned above experienced a relapse after a mean period of 5.0 months. Nonresponders were predominantly patients with severe disease.. Combination treatment with oral rifampicin and clindamycin is a promising treatment option for hidradenitis suppurativa, despite the frequent occurrence of diarrhea as a side effect. The length and the dosage of treatment are not yet firmly established.

Topics: Administration, Oral; Adult; Clindamycin; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Patient Satisfaction; Quality of Life; Retrospective Studies; Rifampin; Severity of Illness Index; Treatment Outcome; Young Adult

Hidradenitis suppurativa (HS) is a chronic inflammatory condition affecting apocrine gland-bearing areas of the skin. There is currently no satisfactory treatment.. To assess the efficacy of a 10-week course of combination clindamycin 300 mg twice daily and rifampicin 300 mg twice daily in the treatment of HS.. Patients who had received combination therapy with clindamycin and rifampicin for HS at one U.K. Dermatology Centre between the years 1998 and 2003 were identified from pharmacy records. Their records were analysed retrospectively.. Fourteen patients with HS had received treatment with combination therapy. Eight of these patients achieved remission and a further two achieved remission when minocycline was substituted for clindamycin. Four patients were unable to tolerate therapy.. This small retrospective study indicates that combination therapy with clindamycin and rifampicin may be effective for HS. However, there is a need for a placebo-controlled trial.

Topics: Adult; Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Retrospective Studies; Rifampin; Treatment Outcome