The Efficacy and Safely of a Combination Benzoyl Peroxide/Clindamycin Topical Gel Compared with Benzoyl Peroxide Alone and a Benzoyl Peroxide/Erythromycin Combination Product

Abstract

French

Background:

Topical clindamycin and benzoyl peroxide have each demonstrated clinical efficacy in the treatment of acne vulgaris. When used in tandem, they promise greater efficacy than either individual agent through their antibacterial and anti-inflammatory effects.

Objective:

To determine the efficacy and safety of combination benzoyl peroxide/clindamycin compared with benzoyl peroxide or benzoyl peroxide/erythromycin in the treatment of acne.

Methods:

In this randomized, 10-week, multicenter, single-blind trial, 492 patients with moderate to moderately severe acne were treated twice daily with 5% benzoyl peroxide/1% clindamycin, 5% benzoyl peroxide, or 5% benzoyl peroxide/3% erythromycin and assessed every 2 weeks.

Results:

Compared with benzoyl peroxide, benzoyl peroxide/clindamycin demonstrated significantly greater reductions in inflammatory lesions (p = 0.04) and significantly greater overall improvement as assessed by physicians (p ⩽ 0.04) and patients (p ≤ 0.001). Benzoyl peroxide/clindamycin demonstrated a nonsignificant trend for greater efficacy compared to benzoyl peroxide/erythromycin. Dry skin was the most frequent (⩽7.3%) adverse event with all three therapies.

Conclusion:

Benzoyl peroxide/clindamycin demonstrated improved efficacy and similar tolerability to benzoyl peroxide used alone and was similar to benzoyl peroxide/erythromycin, making this combination product an effective alternative antimicrobial therapy for acne.

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References

Tucker

Tausend

Cochran

. Comparison of topical clindamycin phosphate, benzoyl peroxide, and a combination of the two for the treatment of acne vulgaris. Br J Dermatol 1984; 110:487–492.

Weiss

. Current options for the topical treatment of acne vulgaris. Pediatr Dermatol 1997; 14:480–488.

Kligman

Leyden

Stewart

. New use for benzoyl peroxide: A broad spectrum antimicrobial agent. Int J Dermatol 1977; 16:413–417.

Decker

Deuel

Sedlock

. Role of lipids in augmenting the antibacterial activity of benzoyl peroxide against Propionibacterium ames. Antimicrob Agents Chemother 1989; 33:326–330.

Mills

Kligman

Pochi

. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol 1986; 25:664–667.

Chalker

Shalita

Smith

JGI

. A double-blind study of the effectiveness of a 3% erythromycin and 5% benzoyl peroxide combination in the treatment of acne vulgaris. J Am Acad Dermatol 1983; 9:933–936.

Lookingbill

Chalker

Lindholm

. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: Combined results of two double-blind investigations. J Am Acad Dermatol 1997; 37:590–595.

Vowels

Yang

Leyden

. Induction of proinflammatory cytokines by a soluble factor of Propionibacterium acnes: Implications for chronic inflammatory acne. Infect Immun 1995; 63:3158–3165.

Esterly

Furey

Flanagan

. The effect of antimicrobial agents on leukocyte Chemotaxis. J Invest Dermatol 1978; 70:51–55.

10.

Plewig

Schöpf

. Anti-inflammatory effects of antimicrobial agents: An in vivo study. J Invest Dermatol 1975; 65:532–536.

11.

Webster

Leyden

McGinley

. Suppression of polymorphonuclear leukocyte chemotactic factor production in Propionibacterium acnes by subminimal inhibitory concentrations of tetracycline, ampicillin, minocycline, and erythromycin. Antimicrob Agents Chemother 1982; 21:770–772.

12.

Leyden

. Therapy for acne vulgaris. N Engl J Med 1997; 336:1156–1162.

13.

Nacht

Yeung

Beasley

Jr. . Benzoyl peroxide: Percutaneous penetration and metabolic disposition. J Am Acad Dermatol 1981;4:31–37.

14.

Eady

Farmery

Ross

. Effects of benzoyl peroxide and erythromycin alone and in combination against antibiotic-sensitive and resistant skin bacteria from acne patients. Br J Dermatol 1994; 131:331–336.

15.

Eady

Bojar

Jones

. The effects of acne treatment with a combination of benzoyl peroxide and erythromycin on skin carriage of erythromycin resistant Propionibacteria. Br J Dermatol 1996; 134:107–113.

16.

Harkaway

McGinley

Foglia

. Antibiotic resistance patterns in coagulase-negative staphylococci after treatment with topical erythromycin, benzoyl peroxide, and combination therapy. Br J Dermatol 1992; 126:586–590.

17.

Guin

Reynolds

Gielerak

. Penetration of topical clindamycin into comedones. J Am Acad Dermatol 1980; 3:153–156.

18.

Shalita

Smith

Bauer

. Topical erythromycin v clindamycin therapy for acne: A multicenter, double-blind comparison. Arch Dermatol 1984; 120:351–355.

19.

Leyden

Berger

Dunlap

. The comparison of a combination topical gel formulation (benzoyl peroxide/clindamycin) with benzoyl peroxide, clindamycin and vehicle gel treatments for acne vulgaris, (submitted).

20.

Tschen

Katz

Jones

. A combination benzoyl peroxide/clindamycin topical gel compared with benzoyl peroxide, clindamycin phosphate, and vehicle in the treatment of acne vulgaris. Cutis 2000 (in press)

21.

Pillsbury

. A Manual of Dermatology. Philadelphia, PA: W.B. Saunders, 1971.

22.

Chu

Huber

Plott

. The comparative efficacy of benzoyl peroxide 5%/erythromycin 3% gel and erythromycin 4%/zinc 1.2% solution in the treatment of acne vulgaris. Br J Dermatol 1997; 136:235–238.