What oral antibiotic can be used for a 17-year-old male with hidradenitis suppurativa?

Oral Antibiotics for Hidradenitis Suppurativa in a 17-Year-Old Male

Oral doxycycline is the recommended first-line oral antibiotic for a 17-year-old male with hidradenitis suppurativa. 1, 2

First-Line Antibiotic Options

Tetracyclines are the preferred first-line systemic antibiotics for HS in adolescents:

• Doxycycline 100mg twice daily for at least 12 weeks is the most appropriate choice for a 17-year-old male 2, 3
  • Well-established safety profile in adolescents ≥8 years old
  • Demonstrated efficacy in reducing inflammatory lesions
  • Provides both antimicrobial and anti-inflammatory effects

Second-Line Antibiotic Options

If doxycycline is ineffective after 12 weeks, consider:

• Combination therapy with clindamycin 300mg twice daily and rifampin 300mg twice daily for 10-12 weeks 2
  • More potent option for moderate-to-severe disease
  • Monitor for potential side effects, particularly gastrointestinal issues
  • Note: Clindamycin carries risk of C. difficile colitis 1, 4

Treatment Algorithm Based on Disease Severity

Mild Disease (Hurley Stage I)

1. Start with doxycycline 100mg twice daily for 12 weeks
2. If inadequate response, consider clindamycin-rifampin combination

Moderate-to-Severe Disease (Hurley Stage II-III)

1. Start with doxycycline 100mg twice daily
2. If inadequate response after 12 weeks, transition to clindamycin-rifampin combination
3. For severe or refractory cases, consider referral for biologic therapy (adalimumab is FDA-approved for patients ≥12 years) 1

Important Clinical Considerations

• Efficacy monitoring: Assess response by improvement in inflammatory lesion count, pain reduction, and quality of life measures after 12 weeks
• Side effect monitoring: Watch for gastrointestinal disturbances, which occur in up to 64% of patients on antibiotics 5
• Duration of therapy: Minimum 12-week course is recommended before determining efficacy 2, 3
• Antibiotic resistance: Consider subantimicrobial dosing (modified-release doxycycline 40mg daily) as an alternative if concerned about long-term antibiotic use 6

Cautions and Contraindications

• Avoid tetracyclines if patient has history of hypersensitivity
• Counsel regarding photosensitivity with doxycycline, especially important for adolescents
• Remind patient to take doxycycline with plenty of water and to remain upright for 30 minutes after taking to prevent esophageal irritation

HS management requires consistent antibiotic therapy for adequate duration, with close monitoring for treatment response and potential side effects.