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Combination Gel Controls Propionibacterium acnes Without Irritation or Development of Microbial Resistance: Presented at EADV

By Jenny Powers

BERLIN -- October 13, 2009 -- An improved acne therapy minimises the risk of antimicrobial resistance, researchers reported here at the 18th Congress of the European Academy of Dermatology and Venereology (EADV).

J. Mark Jackson, MD, Dermatology Specialists, Louisville, Kentucky, headed a team of US researchers that studied the efficacy of a combination treatment of clindamycin phosphate 1% and benzoyl peroxide 5% gel (BPO/C). The results of the study were presented here on October 8.

The 2 active components have different mechanisms of antimicrobial action; benzoyl peroxide has demonstrated efficacy in mitigating Propionibacterium acnes resistance, and clindamycin is an antibiotic that controls bacterial growth.

This study evaluated the antimicrobial efficacy of dual-component BPO/C as compared with clindamycin phosphate 1.2% and tretinoin 0.025% (T/C), wherein just 1 component has antimicrobial activity. Secondary endpoints included tolerability and safety.

The 16-week, 2-centre, investigator-blinded, randomised, parallel-group study enrolled 54 patients to assess the efficacy of both BPO/C and T/C when applied once daily in subjects with moderate to moderately severe facial acne, defined as P acnes counts of at least 10⁴ colony-forming units per square centimetre of skin (CFU/cm²), of which less than 10⁴ CFU/cm² were erythromycin- or clindamycin-resistant. The patients were randomised into 2 equal treatment groups of 27 subjects each.

P acnes counts were reduced in both treatment arms; however, greater reductions were seen in the BPO/C arm at each time point. A reduction of bacterial counts of -94.5 as compared with 0 to 16.8 was seen at week 2 in the BPO/C and T/C arms, respectively. Of additional importance was that a reduction in clindamycin-resistant and erythromycin-resistant P acnes counts was observed in the BPO/C arm only.

There were no treatment-related adverse events in the BPO/C study arm and just 1 in the T/C group.

The authors concluded that BPO/C treatment of moderate to severe acne resulted in a greater reduction of total P acnes together with a decrease in P acnes resistance, which was seen only with BPO/C therapy.

These study results suggest that BPO/C treatment effectively manages acne by reducing P acnes counts. Furthermore, BPO/C treatment decreases the risk of the emergence of antimicrobial resistance to clindamycin or erythromycin.

It was also concluded that the tolerability of BPO/C and the efficacy at 2 weeks make it a highly desirable treatment modality.

Funding for this study was provided by Stieffel, a GSK company.

[Presentation title: Antimicrobial Efficacy of a Benzoyl Peroxide 5%/Clindamycin Phosphate 1% Gel Compared With a Clindamycin Phosphate 1.2%/Tretinoin 0.025% Gel in the Topical Treatment of Acne Vulgaris. Abstract P25]

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