Evaluation of antibiotic therapy in the treatment of hidradenitis suppurativa

Summary: For mild to moderate hidradenitis suppurativa (HS), antibiotics are often prescribed, with oral doxycycline serving as a first-line treatment. However, other oral and topical antibiotics are also used, but studies investigating the efficacy of these therapies have not been conducted. To evaluate this, eleven cohorts were created within TriNetX using International Classification of Disease (ICD)-10 codes, each composed of patients prescribed either oral doxycycline, oral minocycline, oral and topical clindamycin, oral amoxicillin, oral and topical metronidazole, oral moxifloxacin, oral rifampin, or oral and topical dapsone within three years of HS diagnosis. Each cohort was excluded from usage of the other measured medications, adalimumab, secukinumab, or bimekizumab, and excluded from a history of deroofing procedures. The cohorts were evaluated for the need of adalimumab, secukinumab, or bimekizumab within three months to five years following the use of an antibiotic therapy, and a hazard ratio (HR) with 95% confidence intervals (CI) was calculated. Oral doxycycline showed an increased risk of requiring subsequent biologic therapy when compared against the oral amoxicillin cohort (HR= 3.35, 95% CI [2.173, 5.166]), the oral metronidazole cohort (HR= 2.709, 95% CI [1.387, 5.292]), and the oral minocycline cohort (HR= 5.74, 95% CI [1.284, 25.655]). There was no difference between the oral doxycycline and oral clindamycin cohort as well as between the oral and topical clindamycin cohorts. There were not enough measured outcomes to accurately evaluate the other antibiotics. These results question the efficacy of doxycycline monotherapy as a first-line therapy in the treatment of HS. Additional studies should be conducted to further analyze the efficacy of both oral and topical antibiotic monotherapies in the treatment of HS. Megan Bradley², Alyssa Hansen¹, Justine Galambus³, Michael G. Wilkerson¹ 1. Dermatology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States. 2. The University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, United States. 3. Dermatology, Lake Granbury Medical Center, Granbury, TX, United States. Clinical Research: Interventional Research