Arivazhagan, N (2007) Efficacy and Safety of Oral Clindamycin in comparision with Doxycycline in Acne Vulgaris. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Acne vulgaris is a chronic inflammatory disease of pilosebaceous units. It is a common skin disorder affecting both boys and girls in the adolescent age group and also extends into the post adolescent age group. Commonly it is due to formation of obstructing horny plugs in hair follicles, resulting in inflammation around the hair follicles, causing tissue destruction and scar formation. This problem is present universally and affects people of all socio economic groups. With the improvement in the living status, awareness about acne is more among the affected age group causing psychological problems too. From time immemorial, various remedies have been suggested and followed by Ayurvedic, Siddha, Unani practitioners and native healers present in various parts of the world. The scientific evidence of improvement has not been documented yet. Modern medicine also prescribes various drugs, which have been found to be useful in controlling this disorder. All of them have been found to be useful to various extents. Topical drug therapy has been the mainstay and some drugs, for example, tetracycline is given orally. AIM OF THE STUDY: 1. Efficay of oral clindamycin in comparison with doxycyclin in mild to modearte cases of acne vulgaris. 2. Safety of oral clindamycin in comparison with doxycyclin in mild to modearte cases of acne vulgaris. The objective of the study is not only to find out the efficacy of a low dose of 50 mg Clindamycin given orally, but also to find out if this efficacy is obtained without producing the adverse effects for which the administration of Clindamycin is hesitated. The worst complication is pseudomembranous entero colitis. Clindamycin produces very good effect in acne vulgaris and this is discussed later. These effects are produced without significant adverse effects. In few cases reported as Nausea, Vomiting, Diarrhoea were clinically insignificant and they were self limiting. The patients revealed the occurrence of such effects only after questioning them specifically for such an effect. If Diarrhoea, Abdominal pain had been severe they would have definitely reported to the investigator but no one reported. And all of them continued to take the drug without stopping. Here also it should be noted that if Nausea and Vomiting had been due to Pseudomembranous enterocolitis, the condition would have worsened with continuous intake. But the symptoms were self limiting. Only three cases of Dysentry were prescribed tablet Metronidazole by their own doctor. on analyzing the efficacy of oral Clindamycin, a low dose that is 50 mg administered daily for four weeks has definitely produced better results than Doxycycline administered as a single daily dose for 4 weeks. There is significant reduction in the number of Comedons and papules in mild cases of acne vulgaris who have received only oral Clindamycin when compared to other group who have received only oral Doxycycline. This is evident both in the clinical data which has been presented under the results column and also has been found to be statistically significant. In moderate cases, also the significant improvement is seen in the group which is treated with oral Clindamycin. This is reflected as reduction in the number of Comedons, papules and pustules in the Clindamycin treated group, when compared to the other group which is Doxycycline treated control group. The role of Propionibacterium acne in pathogenesis of acne has already been discussed. The anti microbials, Cap.Doxycycline and Cap.Clindamycin act in acne vulgaris by their effect on the Propionibacterium acne. These antibiotics decrease the population of Propionibacterium acne which in turn leads to the inhibition of the bacterial lipases and this is followed by a decrease in concentration of free fatty acids .This produces less tissue inflammation and acne. Since topically applied drugs are widely used in therapy of acne, in the trial groups in which the oral drug therapy was combined with topical Benzoyl peroxide and the outcome was analyzed. Greater efficacy was obtained when oral Clindamycin was combined with topical Benzoyl peroxide. Doxycycline when used alone or in combination with Benzoyl peroxide has retained its efficacy, and the efficacy is greater when combined with topical Benzoyl peroxide. Clindamycin either alone or in combination with topical Benzoyl peroxide 5% cream shows greater efficacy than Doxycycline either alone or in combination with topical Benzoyl peroxide 5% cream. The reason for lesser efficacy of Doxycycline could be due to development of resistance by Propionibacterium acne in some of the patients included in this trial. The literature tells that there is increase in the resistance of Propionibacterium acne to antibiotics worldwide. Clindamycin, though an anti microbial, shows greater efficacy in this study. This could be because Clindamycin oral therapy has not been used so far for acne vulgaris and probably the bacteria have not developed resistance. The better results obtained in a group which has been treated with topical Benzoyl peroxide group could be definitely due to its anti bacterial action and direct anti inflammatory action. CONCLUSION: The study has proved that a low dose of 50 mg of oral Clindamycin administered once a day for four weeks produces good results in acne vulgaris. The good results are obtained without unwanted adverse reactions. For many infections 150 to 300 mg are given 3 – 4 times a day produces many adverse effects. In this trial the low dose of 50 mg used is not only highly effective, but also has not produced any significant adverse reactions. So far, the Clindamycin has only been used topically for acne vulgaris. This study encourages the use of low dose oral Clindamycin in acne vulgaris. Future trials using Clindamycin in combination with the other topical agents like Tretinoin and Adapalene which have different mechanism of actions can be tried. Tretinoin reverses abnormal keratinizing changes in acne vulgaris. Adapalene has got comedolytic property. This trial has been conducted as single centre trial and similar trials will promote wider use of oral Clindamycin in acne vulgaris. This study proves the safety and efficacy of low dose of oral Clindamycin in acne vulgaris, and such low doses can also be tried for other infections where the causative organism responds to Clindamycin.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Efficacy, Safety, Oral Clindamycin, comparision, Doxycycline, Acne Vulgaris. |
| Subjects: | MEDICAL > Pharmacology |
| Depositing User: | Subramani R |
| Date Deposited: | 12 May 2018 17:09 |
| Last Modified: | 23 Aug 2020 14:52 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7743 |
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