What antibiotic is recommended for empiric treatment of Hidradenitis Suppurativa (HS)?

From the Guidelines

For empiric treatment of hidradenitis suppurativa, clindamycin and rifampin in combination is recommended as a first-line treatment for mild-to-moderate disease or as a second-line treatment for severe disease, with a typical dosing of 300 mg twice daily for 10-12 weeks 1.

Key Considerations

• The combination of clindamycin and rifampin has been shown to have response rates from 71% to 93% in patients with hidradenitis suppurativa, making it a highly effective treatment option 1.
• Tetracyclines, such as doxycycline or minocycline, may be considered as an alternative first-line treatment for mild-to-moderate disease, but the evidence suggests that clindamycin and rifampin may be more effective 1.
• For more severe cases, other treatment options such as moxifloxacin, metronidazole, and rifampin in combination, or IV ertapenem, may be considered as second- or third-line treatments 1.

Treatment Approach

• Antibiotics should be used as part of a comprehensive treatment approach that includes lifestyle modifications, proper wound care, and pain management.
• Treatment response should be assessed after 6-12 weeks, and if inadequate, alternative therapies should be considered.
• Long-term antibiotic use should be avoided due to concerns about bacterial resistance.

Important Notes

• The choice of antibiotic and treatment duration should be individualized based on the patient's disease severity, medical history, and response to treatment.
• Patients should be closely monitored for signs of antibiotic resistance, and treatment should be adjusted as needed to minimize the risk of resistance.

From the Research

Empiric Treatment of Hidradenitis Suppurativa with Antibiotics

The treatment of hidradenitis suppurativa (HS) often involves a multifaceted approach, including the use of antibiotics to manage inflammation and prevent infection. Some studies have investigated the efficacy of various antibiotics in the treatment of HS, including:

• Clindamycin, which has been shown to be effective in reducing the severity of HS when used alone 2 or in combination with rifampicin 3
• Tetracycline, doxycycline, and lymecycline, which have been found to be effective in improving HS symptoms and quality of life 4
• Rifampicin, which is often used in combination with clindamycin to treat moderate to severe HS 3

Recommended Antibiotic Regimens

Based on the available evidence, the following antibiotic regimens may be considered for the empiric treatment of HS:

• Clindamycin 300 mg twice daily, either alone or in combination with rifampicin 600 mg daily 3, 2
• Tetracycline 500 mg twice daily, doxycycline 100 mg twice daily, or lymecycline 300 mg twice daily 4

Considerations for Antibiotic Use

When using antibiotics to treat HS, it is essential to consider the potential risks and benefits, including:

• The development of antibiotic resistance, particularly with prolonged use of rifampicin 3
• The potential for side effects, such as gastrointestinal upset or allergic reactions 3, 4
• The importance of combining antibiotic therapy with other treatments, such as topical therapies, retinoids, and lifestyle modifications, to achieve optimal outcomes 5