Clindamycin plus rifampicin safe, effective for Asian patients with hidradenitis suppurativa
Use of the clindamycin–rifampicin combination appears to be safe and effective in the treatment of hidradenitis suppurativa (HS), providing benefits not only to Caucasian patients but also to a group of Asian patients in Singapore, according to the results of a small study.
Specifically, a 10-week course of oral clindamycin and oral rifampin (300 mg twice daily for both) yielded clinical improvements in seven of 11 patients (63.6 percent) treated in a tertiary dermatological centre. [Clin Cosmet Investig Dermatol 2018;11:37-39]
Data from standardized photographs documenting response prior to and after treatment showed that three of four patients achieved clear, minimal or mild scoring on the HS Physician Global Assessment (PGA) at all sites after completion of therapy.
Side effects included nausea and vomiting, reported in only one patient (9.1 percent.) Another patient (9.1 percent) defaulted follow-up.
Of the 11 HS patients (mean age 24.5 years; 81.8 percent male) included in the study, six were Chinese (54.5 percent), four were Malays (36.3 percent) and one was Indian (9.1 percent). The duration of HS prior to initiating combination therapy was 2–20 years. Most patients (72.7 percent) had been treated previously with retinoids and antibiotics, although with limited effect and persistent disease.
The efficacy and tolerability of clindamycin plus rifampin for HS had been assessed previously in four studies, the authors noted. “Overall results are promising with reported improvement rates between 71.4–85.7 percent. Statistically significant improvements in all quality-of-life dimensions of the Skindex-France questionnaire were also described in one study.” [J Eur Acad Dermatol Venereol 2014;28:125-126; Dermatology 2009;219:148-154; Br J Dermatol 2006;154:977-978; Dermatology 2009;219:143-147]
“Other studies have similarly described good tolerability with low rates of side effects between 13.0–38.2 percent. Gastrointestinal complaints were most commonly reported, but there were no cases of clindamycin-associated Clostridium difficile colitis,” they added.
While HS is a chronic inflammatory disease of follicular occlusion and not primarily an infectious disease, Staphylococcus aureus and Staphylococcus epidermidis are pathogens reported to be most frequently isolated as secondary colonizers in affected patients.
In treating HS, the beneficial effects of clindamycin and rifampin may be attributed to both their antibacterial and anti-inflammatory properties, the authors pointed out.
A lincosamide antibiotic that is active against Gram-positive cocci and anaerobic bacteria, clindamycin mediates inflammation by suppressing complement-derived chemotaxis of polymorphonuclear leukocytes. On the other hand, rifampicin is a lipid-soluble, broad-spectrum antibiotic highly effective against S. aureus. This drug also modifies cell-mediated hypersensitivity by suppressing antigen-induced transformation of sensitized lymphocytes, and rapid emergence of bacterial resistance may result with monotherapy. [Infection 1996;24:275–291]
“Hence, combination therapy is synergistic with reduced resistance rates and increased anti-inflammatory properties. Although a longer duration of treatment appears warranted in chronic diseases like HS, no large differences in outcome between patients treated for ≥10 weeks and those treated for a shorter period have been reported,” the authors said.