Bacteriology of Hidradenitis Suppurativa – Which Antibiotics are the Treatment of Choice?

Abstract

The bacterial superinfection in hidradenitis suppurativa (HS), although it does not initiate the disease itself, seems to be one of the major contributors to an inflammatory vicious circle. Antibiotic therapy is therefore commonly prescribed in HS. This study was undertaken to evaluate the prescription of systemic antibiotics in the light of bacteriological cultures and antibiograms. The study was conducted on a group of 69 patients with HS. The huge majority (n=62) of the patients were treated with antibiotics. The antibiotics were prescribed 132 times and taken for a mean period of 9.9 ± 8.9 weeks. The most commonly used antibiotic was doxycycline (16.7%). The majority of the patients had a polymicrobial flora with up to 5 species, predominantly staphylococci and bacteria of intestinal flora. The highest effectiveness against isolates was observed for carbapanems, penicillins with β-lactamase inhibitors and fluoroquinolones - 8.5%, 11.9%, and 11.9% of resistant strains, respectively. In daily practice penicillins with β-lactamase inhibitors or fluoroquinolones could serve as first-line therapy of HS.

An Update on Medical Treatment Options for Hidradenitis Suppurativa

“…Furthermore, they can inhibit angiogenesis [35], which is a common process in HS inflammation. Because of these anti-inflammatory properties and a mild side-effect profile, tetracyclines are useful for longterm treatment and stabilization of HS [29,33]. However, they are less effective in treating or preventing exacerbations of HS.…”

“…However, they are less effective in treating or preventing exacerbations of HS. Matusiak et al [29] cultured the bacteria isolated from HS patients and found that 64 % of the isolated strains were resistant for tetracyclines. In addition, in a randomized double-blind controlled trial, topical clindamycin 1 % lotion was shown to be as effective as systemic tetracycline 500 mg twice daily in terms of number of nodules and abscesses and patient pain score [37].…”

“…Antibiotics from the tetracycline group are the first-line systemic treatment for HS [20,29,33]. Tetracyclines are broad-spectrum antibiotics and act by inhibition of bacterial protein synthesis through reversible binding to the 30S ribosomal subunit [34].…”

Nonredundant Roles of Interleukin-17A (IL-17A) and IL-22 in Murine Host Defense against Cutaneous and Hematogenous Infection Due to Methicillin-Resistant Staphylococcus aureus

“…In comparison, autosomal dominant hyper-IgE syndrome patients have deficient Th17 response and are at increased risk for SSSI but not for disseminated S. aureus infection (25). Furthermore, patients with acne inversa have deficits in cutaneous interleukin-22 (IL-22) responses and exhibit staphylococcal persistence in skin abscesses (26,27). These patterns suggest that innate and adaptive immune responses must cooperate for optimal host defense against MRSA.…”

Innate Immune Memory Contributes to Host Defense against Recurrent Skin and Skin Structure Infections Caused by Methicillin-Resistant Staphylococcus aureus

“…In comparison, because they have a defective Th17 response, patients with Job's syndrome (hyper-IgE syndrome) and atopic dermatitis are at increased risk of SSSI, but typically less so for systemic S. aureus infection (34)(35)(36). Further, patients with acne inversa exhibit staphylococcal persistence in skin abscesses due to deficiencies in the cutaneous interleukin-22 (IL-22) response (37,38). Thus, different aspects of the host immune system are required to defend cutaneous versus hematogenous compartments against S. aureus infection.…”