Comparison of efficacy and safety of oral azithromycin and oral doxycycline in acne vulgaris

Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit with considerable psychosocial impact. Oral azithromycin or oral doxycycline can be used for the management of moderate and severe acne vulgaris. However, there is no consensus on which antibiotic is superior and the optimal dose for management.Methods: A prospective randomized interventional study was carried out among 120 patients of moderate to severe acne vulgaris. The patients were randomized into group A and B. While group A was prescribed oral azithromycin 500 mg three times a week, group B was given oral doxycycline 100 mg daily for 12 weeks. Topical clindamycin twice daily application was also given. Global Acne Grading Scale (GAGS) score was recorded at baseline and at 2nd, 4th, 8th and 12th weeks.Results: GAGS score at baseline in azithromycin (n = 53) and doxycycline (n = 55) group was 31.98±4.49 and 30.63±3.78 respectively (p value >0.05). 83.91±6.83% (p <0.001) and 81.87±6.75% (p <0.001) improvement was seen in azithromycin group and doxycycline group after 12 weeks of treatment. However, there was no difference in the GAGS score between the groups at any follow-up (p value >0.05). 15.09% patients in azithromycin group and 20% patients in doxycycline group reported adverse effects. The most commonly reported adverse effect was diarrhoea. All adverse effects were of ‘mild’ category and causality assessment was ‘possible’.Conclusions: Oral azithromycin is equally efficacious but safer alternative to oral doxycycline for the management of acne vulgaris