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Br J Dermatol. 2018 Oct 3. doi: 10.1111/bjd.17265. [Epub ahead of print]

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

Author information

1
Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, 1900 West Polk Street, Chicago, IL, 60612, U.S.A.
2
Department of Dermatology, Rush Medical College, Chicago, IL, U.S.A.
3
Countway Library of Medicine, Harvard Medical School, Boston, MA, U.S.A.
4
Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.
5
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
6
Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, U.S.A.

Abstract

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.

PMID:
30281779
DOI:
10.1111/bjd.17265

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