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Combination Antimicrobial Therapy Improves Severe HS

A combination antimicrobial treatment may be an effective option for patients with severe Hurley stage 1 hidradenitis suppurativa (HS1), according to the findings of a recent study.

“Severe HS1 is a difficult to treat form of the disease,” the researchers said. They assessed the efficacy of oral combination therapy, which included once-daily rifampin (10 mg/kg), once-daily 400 mg moxifloxacin, and twice-daily 250 mg to 500 mg metronidazole, among 28 participants. The primary endpoint included a Sartorius score of 0, considered clinical remission, at week 12.

Overall, 19 participants completed 6 weeks of treatment with the combination therapy followed by 4 weeks of rifampin and moxifloxacin alone followed by cotrimoxazole after achieving clinical remission. Nine patients were switched from moxifloxacin to pristinamycin due to contraindications or intolerance.

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By week 12, 75% of patients achieved clinical remission, with the median Sartorius score dropping from 14 to 0, the researchers said. A low initial Sartorius score was a prognostic factor for clinical remission, they noted. After a year of follow up, the median number of flares dropped from 21 per year to 1, they added.

“Complete and prolonged remission can be obtained in severe HS1 using targeted antimicrobial treatments,” the researchers concluded.


Delage M, Jais JP, Lam T, et al. Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley Stage 1 Hidradenitis Suppurativa: prospective short-term trial and one-year follow-up in 28 consecutive patients [published online January 10, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.01.007

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