Long-term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa. A Critically Appraised Topic

J Albrecht, P A Baine, B Ladizinski, G B Jemec, M Bigby

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Abstrakt

CLINICAL QUESTION/SCENARIO: Can therapy with clindamycin and rifampicin be safely continued long term beyond the recommended 10-week course?

BACKGROUND: Clindamycin and rifampicin are used in combination to treat hidradenitis suppurativa (HS). There is no data on the efficacy and safety of clindamycin/rifampicin combination therapy for HS beyond 10 weeks.

METHODS: We identified the following major concerns that still lack a proper evidenced-based analysis: for rifampicin, drug-induced liver injury, interstitial nephritis, drug interaction and hepatic p450 3A4 enzyme induction; for clindamycin, the concern was community-acquired Clostridium difficile infection (CA-CDI); and experience with long-term treatment. Data sources were used as appropriate to answer the question. Systematic searches were used to assess the risk of CA-CDI and experience with long-term treatment with clindamycin.

RESULTS/IDENTIFIED EVIDENCE: The risk for rifampicin-induced liver injury is highest in the first 6 weeks of treatment, whereas interstitial nephritis is primarily observed during intermittent treatment. Enzyme induction due to rifampicin is usually complete after about 2 weeks of treatment and reduces clindamycin blood levels by about 90%. Three meta-analyses identified antibiotic use as a risk factor for CA-CDI. Two of them assigned the highest risk to clindamycin. None of them stratified by length of treatment. There is extensive experience with rifampicin, primarily for the treatment of tuberculosis. Long-term experience with clindamycin is limited.

DISCUSSION AND RECOMMENDATION FOR CLINICAL CARE: The analysed risks associated with a combination of clindamycin and rifampicin for hidradenitis suppurative cluster within the first 10 weeks. Treatment can be continued beyond 10 weeks, if clinically necessary.

OriginalsprogEngelsk
Sider (fra-til)749-755
Antal sider7
TidsskriftBritish Journal of Dermatology
Vol/bind180
Udgave nummer4
DOI
StatusUdgivet - apr. 2019

Bibliografisk note

© 2018 British Association of Dermatologists.

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