Department of Dermatology, University of Pisa, Pisa, Italy.
Clinical trial office, Scientific directorate, E.O. Ospedali Galliera, University of Genoa, Genoa, Italy.
Dermatol Ther. 2021 May;34(3):e14919. doi: 10.1111/dth.14919. Epub 2021 Mar 7.
The combination of oral clindamycin with rifampicin is recommended by European guidelines as a first-line treatment in moderate-to-severe hidradenitis suppurativa (HS). Recent studies highlight that oral clindamycin in monotherapy (CM) may be a useful alternative treatment. We included 36 patients with a diagnosis of moderate-to-severe HS. A total of 19 patients were treated with combination oral clindamycin plus rifampicin (C + R) and 17 with oral CM for 12 weeks. The efficacy of CM vs C + R was analyzed by multilinear regression models which showed a higher reduction in mSartorius (Δ = -13.2, P = .058) and AISI (Δ = -4.91, P = .034) in the C + R group. In the C + R group, smoking pack-year was positively correlated with AISI (Spearman's rho = 0.51, P = .036) and with DLQI (0.47, P = .061). In the CM group, a positive correlation was found between BMI and AISI (0.47, P = .041). The data on the efficacy of C + R combination therapy are in line with guidelines, evidence-based approaches, and recommendations from the HS ALLIANCE working group. The rationale for combining these two drugs is to increase bactericidal action and to reduce rifampicin resistance, as rifampicin is highly mutagenic. Our results suggest that the antibiotic combination of C + R is still the treatment of choice in moderate-to-severe HS with abscesses, draining fistulae and ≥ 5 inflammatory nodules. High BMI and smoking habits seem to be predictive factors of a poor response to antibiotics. Further multicenter studies and prospective randomized controlled trials are needed to confirm these results. Potential alternative antibiotic therapies should also be investigated.
欧洲指南推荐口服克林霉素联合利福平作为中重度化脓性汗腺炎（HS）的一线治疗药物。最近的研究强调，口服克林霉素单药治疗（CM）可能是一种有用的替代治疗方法。我们纳入了 36 例中重度 HS 患者。共有 19 例患者接受口服克林霉素联合利福平（C+R）治疗，17 例患者接受 CM 治疗 12 周。采用多元线性回归模型分析 CM 与 C+R 的疗效，结果显示 C+R 组 Sartorius 评分（Δ=-13.2，P=0.058）和 AISI 评分（Δ=-4.91，P=0.034）降低更明显。在 C+R 组中，吸烟包年与 AISI（Spearman 相关系数=0.51，P=0.036）和 DLQI（0.47，P=0.061）呈正相关。在 CM 组中，BMI 与 AISI 呈正相关（0.47，P=0.041）。C+R 联合治疗疗效的数据与指南、循证方法和 HS ALLIANCE 工作组的建议一致。联合使用这两种药物的原理是增加杀菌作用并减少利福平耐药性，因为利福平具有高度致突变性。我们的结果表明，对于伴有脓肿、引流性瘘管和≥5 个炎症性结节的中重度 HS，C+R 抗生素联合治疗仍然是首选治疗方法。高 BMI 和吸烟习惯似乎是对抗生素反应不良的预测因素。需要进一步开展多中心研究和前瞻性随机对照试验来证实这些结果。还应研究其他潜在的替代抗生素治疗方法。
