Azithromycin versus tetracycline in the treatment of acne vulgaris

Background: Acne vulgaris affects a large number of young adults and often presents with facial and truncal involvement. Systemic antibiotics are used for the treatment of papulopustular and cystic lesions. Objective: We sought to determine the efficacy and safety of azithromycin versus tetracycline in the treatment of acne vulgaris. Methods: A randomized, investigator-blind, clinical trial was carried out for 3 months at the outpatient clinic of Emam Khomeini University Hospital, Ahwaz, Iran. A total of 290 patients with moderate to severe papulopustular acne vulgaris were allocated to two groups, azithromycin and tetracycline, for 3 months of treatment. Azithromycin 500 mg was prescribed for 3 consecutive days a week for 1 month and then 250 mg every other day for the following 2 months. Tetracycline 1 g was similarly prescribed: daily for 1 month and then 500 mg daily for the following 2 months. Results: Both antibiotics were effective in reducing inflammatory lesions and improving acne. Azithromycin produced a slightly higher percentage of improvement compared with tetracycline (100 cases/84.7% vs 94 cases/79.7%). Conclusion: Azithromycin is a safe and effective alternative in the treatment of inflammatory acne.