Topical Metronidazole

Metronidazole is a nitroimidazole that has antibiotic and antiprotozoal effects. It was first used for vaginal trichomanas in the 60’s. Oral metronidazole reported to be useful in rosacea in 1976(Burton JL Lancet 1976 - 1:1211-12) and used topically since 1979.

How Do I Use This Medication?

Topical metronidazole is available in a gel, cream and lotion. It should be applied once or twice a day on the affected area. In the case of rosacea this may be the whole face although the involvement is usually on the central face. It is applied as a thin layer on the skin.

How Well Does It Work?

In Rosacea it reduces the inflammatory papules and pustules and has little or no effect on the flushing or vascular component of the disease. It has been shown to reduce the papules and pustules by about 65% over a nine week course. The Metrogel formulation may have increased penetration into the skin but may also cause some stinging.

Topical treatment is one way of avoiding oral antibiotics but in very inflammed cases oral treatment may be required initially. It is about as effective as oral tetracycline (NielsenPG Br J Dermatol 1983;109:63-65) Relapses after oral antibiotics can be reduced and the condition controlled by prolonged topical therapy. (Dahl MV Arch Dermatol 1998;134:679-83) Noritate cream (1% metronidazole) has been shown to work with daily dosing only. It is not helpful for rhinophyma, telangiectasias or eye roasea.

How Does It Work?

It works through multiple actions. It is antibacterial as well as being anti-inflammatory influencing neutrophil function. It may also have an action as an antioxidant. It has little effect against Demodex which is a mite found in the hair follicles and does not influence sebum production.

Will There Be Side Effects?

Local:

Systemic:

Which Brands Are Available?

What Other Conditions Are Treated By This Medication?

Minocycline (Minocin®, Dynacin®, Vectrin®)

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INTRODUCTION
Minocycline inhibits the growth of Propionibacterium acnes. Anti-inflammatory actions. Drug Class: Antibiotic, Anti-inflammatory-long acting tetracycline... | Read more ...

CLININCAL EXPERIENCE
Oral antibiotics have had a significant role in the treatment of inflammatory disease such as acne, rosacea, perioral dermatitis and others. Tetracycline has long been the first line antibiotic for acneform eruptions because of its efficacy and affordability although in inconvenience of divides doses on an empty stomach has compromised compliance in some. P. acnes resistance to Tetracycline and Erythromycin has meant looking elsewhere for an alternative antibiotic. Bacterial resistance to Minocycline has been much slower to develop... | Read more ...

INDICATIONS
Labeled Indications: Dermatologic Dermatologic: Acne vulgaris, Inflammatory acne, Anthrax, Chancroid, Granuloma inguinale, Lymphogranuloma venerum, Skin and soft tissue infections , Syphilis, Yaws... | Read more ...

PATIENT PROFILE
Any inflammatory acne or rosacea patient who is not likely to respond to topical therapy alone. If scarring present or nodulocystic acne a more aggressive approach may be necessary... | Read more ...

DOSING
Capsules: Minocycline 50 and 100mg (Minocin* Dynacin*) Suspension: Minocycline 50mg (Minocin* Dynacin*) Parenteral: Minocycline 100mg (Minocin IV*) ... | Read more ...

EFFICACY
Improvement in inflammatory lesion in acne is about a 20% reduction a month. It may take 1-2 months to see initial benefit. After 6 months there is an approximate 60-70% improvement in inflammatory acne counts. Studies over the last 20 years have shown that tetracycline, erythromycin, doxycycline and minocycline have about the same efficacy in acne... | Read more ...

COMPLIANCE
All tetracyclines are broad-spectrum bacteriostatic agents. They are well absorbed, although oxytetracycline and tetracycline should not be taken with food. Minocycline as well as Doxycycline are absorbed almost as well on an empty as full stomach... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Discard outdated tetracyclines as degradation products may be toxic. Not recommended in pregnancy and in children under 8 years of age as permanent enamel hyperplasia, discoloration of teeth, and inhibition of fetal skeletal growth may occur... | Read more ...

COST OF TREATMENT
Cost of treatment of 1 month of standard dose for acne: Minocycline 100 mg daily for 1 month $42. Tetracycline 1gm daily for 1 month ... | Read more ...

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