Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

Abstract

The rifampicin (RF)–clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy. The aim of the present study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS. In the period January 2017–May 2018, 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by Revuz, Hidradenitis Suppurativa Physician Global Assessment [HS‐PGA] and International Hidradenitis Suppurativa Severity Score System [IHS4]) before (W0) and after (W12) CL oral therapy. CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p ≤ .01). There was also a statistically significant change in the mean visual analogue scale for pain. The present study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF–CL combination in a selected group of patients.

Tuscan consensus on the diagnosis and treatment of hidradenitis suppurativa

“…A possible alternative is represented by systemic clindamycin (300 mg b.i.d.) alone as observed by our group …”

“…alone as observed by our group. 13 Adalimumab (160 mg on day 1, 80 mg on day 15, and a single 40 mg injection every week from week 4 onwards, or 80 mg every other week) is the first-choice biologic treatment for moderate/severe patients with HS after failure of conventional treatments.…”

Clindamycin Mono-Therapy of Hidradenitis Suppurativa Patients: A Single-Center Retrospective Study

“…It has been confirmed that CL mono-therapy may be a useful treatment alternative to the antibiotic combination. Rosi et al 9 also showed comparable results confirming the effectiveness of CL mono-therapy in HS. Caposiena Caro et al 8 reported the efficacy of CL mono-therapy according to severity assessed by Hi-SCR in which 100% of Hurley’s stage I patients, 68.4% of Hurley’s stage II patients, and 0.0% of Hurley’s stage III patients achieved Hi-SCR.…”

“…Caposiena Caro et al 8 reported the efficacy of CL mono-therapy according to severity assessed by Hi-SCR in which 100% of Hurley’s stage I patients, 68.4% of Hurley’s stage II patients, and 0.0% of Hurley’s stage III patients achieved Hi-SCR. Also, CL efficacy was observed to be higher in mild to moderate than severe to very severe cases assessed by HS-PGA in Rosi’s study 9 . Also, in the RF-CL combination therapy, the non-response rate to the combination therapy was also the highest in Hurley’s stage III 10 .…”

Systemic antibiotics in hidradenitis suppurativa: efficacy and effects of body mass index and smoking pack‐year on the response to therapy

“…The first study on clindamycin as a monotherapy in HS was published in 2019 on 31 patients, which reported a mean mSartorius score reduction of 42.5% at W12. No data on long‐term follow‐up were reported 6 . In our study for 17 patients, the mSartorius score reduction for CM at W12 was 56.6% but follow‐up after 6 months showed an average number of flares equal to five and only 35% of patients (6/17) managed the disease with topical treatment without resorting to new cycle of systemic antibiotic therapies nor switching to biological treatments.…”