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. 2023 May 29;12(6):978. doi: 10.3390/antibiotics12060978

Table 2.

Studies evaluating the activity of systemic antibiotics in HS.

Treatment Authors Study N Patients’ Characteristics Study Design
Endpoints		 Outcomes
CLINDAMYCIN (Monotherapy and combinations)
Clindamycin [23] Clemmensen O.J. et al., 1983 Double-blind trial 30 Hurley stage not specified Clindamycin vs. placebo Clindamycin significantly superior to placebo except for inflammatory nodules and abscesses at each monthly evaluation (p less than 0.01)
Clindamycin [24] Jemec G.B.E. et al., 1998 Double-blind placebo-controlled RCT 46 Hurley stage I or II HS Tetraciclyne 1 g/die PO + topical placebo vs. placebo PO + topical clindamycin 1% for at least 3 mo No significant differences between the two treatments in terms of VAS score Patients’ global assessment of disease was significantly worse than physician’s assessment in 3 of 5 evaluations (p = 0.0096 to 0.015), but the correlation between patients’ and physicians’ assessments was satisfactory after only one visit (rs = 0.761 to 0.895)
Clindamycin [25] Molinelli E. et al., 2020 Retrospective study 124 Hurley stage I or II HS

  • Topical clindamycin 1% (N = 739).

  • Topical resorcinol 15% (N = 61).

 Patients treated with resorcinol 15% showed a significant improvement in HS clinical response, international HS severity core system and pain visual analogue scale score from baseline compared to patients treated with clindamycin; In group A (clindamycin 1%), clinical response (HiSCR) was obtained in 38 (52%) of 73 patients after 12 weeks (p < 0.01). In group B (resorcinol 15%), clinical response was achieved in 52 (85.3%) of 61 patients after 12 weeks (p < 0.001). At 12 weeks, the clinical response to resorcinol 15% was higher than the response to topical antibiotic, with statistically significance (p < 0.001).
Clindamycin [32] Caposiena Caro R.D. et al., 2019 Retrospective study 60 Hurley stage I or II HS

  • Group A: clindamycin 150 mg 4 times a day + rifampicin 300 mg BID.

  • Group B: clindamycin 150 mg 4 times a day.

 After 8 weeks of treatment the responses to antibiotics were similar in both groups.
Clindamycin [13] An J.H. et al., 2021 Retrospective study 53 Hurley stage II or III HS Clindamycin monotherapy for 8 weeks Improvement in rate of HS clinical response (Hi-SCR) achievers and comparing HS physician’s global assessment (HS-PGA) before (W0) and after (W8) the treatment. Twenty-one patients (61.76%) achieved Hi-SCR. The mean scoring of HS-PGA had significantly decreased from 3.24 to 2.15 (p = 0.001).
Clindamycin-rifampicin [28] Gener G. et al., 2009 Retrospective study 116 Hurley stage III HS Clindamycin (300 mg PO BID) + rifampicin (600 mg PO daily) Improvement of median Sartorius score at the end of treatment (29 vs. 14.5; p < 0.001), and of QoL score.
Clindamycin-rifampicin [30] van der Zee H.H. et al., 2009 Retrospective study 34 Hurley stage I, II, III HS Clindamycin (300 mg PO BID) + rifampicin (600 mg PO daily) Partial improvement: 82%; total remission: 47% (maximum effect of treatment within 10 weeks). Following total remission, 8 of 13 (61.5%) patients treated as mentioned above experienced a relapse after a mean period of 5.0 months.
Clindamycin-rifampicin [31] Dessinioti C. et al., 2016 Prospective study 26 Hurley stage I, II, III HS Clindamycin (300 mg PO BID) + rifampicin (600 mg PO daily) for 12 weeks 12-week clinical response rate: 73%; At the 1-year follow-up, there was sustained efficacy in 7 (41%) patients, while 10 (59%) had disease relapse after a mean time of 4.2 months.
Clidamycin-Oxofloxacin [34] Delaunay J. et al., 2018 Retrospective study 65 Hurley stage I, II, III HS Clindamycin (600–1800 mg) + oflaxacin (200–400 mg) Efficacy in disease control in HS.
Thirty-eight patients (58.4%) reported improvement of disease activity under OC with complete response for 22/65 (33.8%) and partial remission in 16/65 (24.6%) patients.
TETRACYCLINES
Minocycline [37] [37] K. et al., 2017 Prospective study 20 Hurley stage I, II, III HS Minocycline 100 mg PO + colchicine 0.5 mg BID for 6 months, followed by colchicine maintenance 0.5 mg BID for 3 months Efficacy in disease control in HSPhysician global assessment (PGA) scale (PGA) shows good and excellent response in 95% of patients at 9 months.
Limecycline [20] Caposiena Caro R.D. et al., 2021 Retrospective study 52 Hurley stage I, II, III HS

  • Group A (N = 26): lymecycline 300 mg daily for 10 weeks.

  • Group B (N = 26): clindamycin 600 mg + rifampicin 600 mg for 10 weeks.

 Both treatments are effective in terms of IHS4, pain VAS scale and DLQI for patients with moderate-severe HS. Response rates at the end of the treatments were similar in both groups (p = 0.78): 57.7% in group A and 53.8% in group B met the primary outcome (HiSCR).
Tetracycline [36] Jørgensen A.R. et al., 2021 Prospective study 143 Hurley stage I, II, III HS

  • Tetracycline 500 mg PO BID.

  • Doxycycline 100 mg PO BID.

  • Lymecycline 300 mg PO BID.

 All treatments were effective and safe in HS patients. Tetracycline provided the greatest clinical improvement mean The mean HSS at baseline was 26.10 (SD 20.18) points, improving to 17.97 (SD 17.88) at follow-up, difference is 8.13 (95% CI 5.21–10.93), p < 0.0001 sured by HSS.
ERTAPENEM
Ertapenem [40] Join-Lambert O. et al., 2016 Retrospective study 30 Hurley stage III Ertapenem 1 g die for 6 weeks + antibiotic consolidation treatments for 6 months (M6) in severe HS Dramatic improvement of severe HS provided by ertapenem.
The median (IQR) Sartorious score dropped from 49.5 (28–62) at baseline to 19.0 (12–28) after ertapenm (p < 10−4).
Ertapenem
[3]		 Braunberger T.L. et al., 2018 Retrospective study 36 Hurley stage II, III HS Ertapenem 1 g die Clinical improvement in 97.2% of patients and an improvement in quality of life in 85.7% of patients.
METRONIDAZOLE (monotherapy and combinations)
Metronidazole [50] Delage M. et al., 2023 Prospective trial 28 Hurley stage I HS Rifampicin + moxifloxacin + metronidazole The primary endpoint was a Sartorius score of 0 (clinical remission) at week 12. The median Sartorius score dropped from 14 to 0 (p = 6 × 10−6) at week 12, with 75% of patients reaching clinical remission.
Ceftriaxone + Metronidazole
[51]		 Nassif A et al., 2012 Case report 4 Hurley stage II HS Ceftriaxone IV + metronidazole PO Improvement of HS
DALBAVANCIN
Dalbavancin [6] Molinelli E. et al., 2022 Retrospective study 8 Hurley stage I, II or III HS Dalbavancin 100 mg IV Significant disease improvement at 12 weeks; Significant disease improvement was achieved at 12 weeks (T12) with average values of 7 for IHS4, 2 for pain VAS, and 8 for DLQI, and HiSCR was satisfied in six out of eight patients compared to baseline (T0)

Keys: BID: bis in die; Hi-SCR: Hidradenitis suppurativa clinical response; HS: hidradenitis suppurative; mo: months; N: number; HS-PGA: Hidradenitis suppurativa-physician’s global assessment; IHS4: Hidradenitis suppurativa severity score system; PO: per os; RCT: Randomize clinical trials; VAS: Visual analogue scale.