What is the recommended antibiotic therapy for hidradenitis suppurativa?

From the Guidelines

The recommended antibiotic therapy for hidradenitis suppurativa typically involves tetracycline antibiotics as first-line treatment, with doxycycline or minocycline being common regimens, as supported by the most recent guidelines 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the disease, with topical Clindamycin 1% solution/gel or oral Tetracycline 500 mg twice daily for 4 months considered for mild disease 1.
• For more severe cases or those unresponsive to first-line treatment, a combination of Clindamycin 300 mg twice daily and Rifampicin 600 mg once daily for 10 weeks may be considered 1.
• The use of antibiotics should be part of a comprehensive approach that includes lifestyle modifications, topical treatments, and in severe cases, consideration of biologics or surgical interventions.

Important Factors

• The diagnosis of hidradenitis suppurativa should be made by a dermatologist or other healthcare professional with expert knowledge in the condition 1.
• Patients should be assessed for disease severity using scores such as Hurley staging and physician global assessment, and patient-reported outcomes including DLQI, itch, and pain assessment should be routinely used 1.
• The need for surgical intervention should be assessed in all patients, depending on the type and extent of scarring, and an evidence-based surgical approach should be implemented 1.

From the Research

Antibiotic Therapy for Hidradenitis Suppurativa

The recommended antibiotic therapy for hidradenitis suppurativa (HS) can vary depending on the severity of the disease and the patient's overall health.

• Combination therapy with clindamycin and rifampicin is often recommended for moderate to severe HS, as it has been shown to be effective in reducing disease severity and improving quality of life 2, 3, 4.
• Clindamycin monotherapy may also be a useful alternative treatment for HS, particularly for patients who cannot tolerate rifampicin or have concerns about its potential side effects 3, 5.
• The efficacy of antibiotic therapy can be influenced by factors such as body mass index (BMI) and smoking habits, with higher BMI and smoking pack-years potentially leading to a poorer response to treatment 3.

Specific Antibiotic Regimens

• Clindamycin 300 mg twice daily and rifampicin 600 mg daily for 10 weeks has been shown to be effective in reducing disease severity and improving quality of life in patients with severe HS 2.
• Clindamycin 300 mg twice daily as monotherapy for 12 weeks has also been demonstrated to be effective in reducing disease severity and improving quality of life in patients with HS 5.
• The combination of clindamycin and rifampicin may be more effective than clindamycin monotherapy in reducing disease severity, particularly in patients with moderate to severe HS 3.

Considerations for Antibiotic Therapy

• Antibiotic therapy should be used in conjunction with other treatments, such as topical therapies, retinoids, and lifestyle modifications, as part of a multimodal approach to managing HS 6.
• The potential risks and benefits of antibiotic therapy should be carefully considered, particularly in patients with a history of antibiotic resistance or other underlying health conditions.
• Further research is needed to fully understand the efficacy and safety of different antibiotic regimens for HS, as well as to identify potential alternative treatments for patients who do not respond to current therapies 3.