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Vol. 222, No. 1, 2011
Issue release date: February 2011
Dermatology 2011;222:49–58

Efficacy of Rifampin-Moxifloxacin-Metronidazole Combination Therapy in Hidradenitis Suppurativa

Join-Lambert O. · Coignard H. · Jais J.-P. · Guet-Revillet H. · Poirée S. · Fraitag S. · Jullien V. · Ribadeau-Dumas F. · Thèze J. · Le Guern A.-S. · Behillil S. · Leflèche A. · Berche P. · Consigny P.H. · Lortholary O. · Nassif X. · Nassif A.
aUniversité Paris Descartes, Faculté de Médecine Paris Descartes, bLaboratoire de Microbiologie, cService des Maladies Infectieuses et Tropicales, dService d’Informatique Médicale et de Biostatistiques, eService de Radiologie Adulte, fService d’Anatomie et de Cytologie Pathologiques, Hôpital Necker-Enfants malades, Assistance-Publique-Hôpitaux de Paris, gService de Pharmacologie Saint-Vincent-de-Paul, Assistance-Publique-Hôpitaux de Paris, hCentre Médical, iCellule d’Intervention Biologique d’Urgence Institut Pasteur (CIBU), jINSERM U1002 and kCentre d’Infectiologie Necker-Pasteur, Paris, France

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Background: Antibiotics have been shown to improve hidradenitis suppurativa (HS) patients but complete remission is rare using these treatments. Objective: To assess the efficacy and safety of a combination of oral rifampin, moxifloxacin and metronidazole in long-lasting refractory HS. Methods: We retrospectively studied 28 consecutive HS patients including 6, 10 and 12 Hurley stage 1, 2 and 3 patients, respectively. Complete remission, defined as a clearance of all inflammatory lesions including hypertrophic scars, was the main outcome criterion of the study. Results: Complete remission was obtained in 16 patients, including 6/6, 8/10 and 2/12 patients with Hurley stage 1, 2 and 3, respectively (p = 0.0004). The median duration of treatment to obtain complete remission was 2.4 (range 0.9–6.5) and 3.8 months (range 1.6–7.4) in stage 1 and 2 patients, respectively, and 6.2 and 12 months in the 2 stage 3 patients. Main adverse events of the treatments were gastrointestinal disorders (64% of patients) and vaginal candidiasis (35% of females). Reversible tendinopathy and hepatitis occurred in 4 and 1 patient, respectively. Conclusions: Complete remission of refractory HS can be obtained using broad-spectrum antibiotics and Hurley staging is a prognostic factor of response to the treatment.

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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