Comparative Evaluation of Oral Azithromycin and Doxycycline in Patients with Acne Vulgaris:

Tarun  Sharma; Poonam  Singh; Kavita Dhar  Bagati; Suruchi  Mathur; Amit  Singhal

Tarun Sharma Department of Pharmacology, Saraswathi Institute of Medical Sciences, Hapur, India.
Poonam Singh Department of Pharmacology, Saraswathi Institute of Medical Sciences, Hapur, India.
Kavita Dhar Bagati Department of Pharmacology, Saraswathi Institute of Medical Sciences, Hapur, India.
Suruchi Mathur Department of Biochemistry, Saraswathi Institute of Medical Sciences, Hapur, India.
Amit Singhal Department of Pharmacology, Maharishi Markandeswar, Institute of Medical Science & research, Mullana, Ambala, Haryana, India.

Keywords: Acne vulgaris, Azithromycin, Doxycycline, Systemic antibiotics, Acne severity score

Abstract

Background: Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit affecting a large proportion of adolescents and young adults. Systemic antibiotics remain an important component in the management of moderate inflammatory acne due to their antimicrobial and anti-inflammatory properties. Among the commonly prescribed antibiotics, doxycycline and azithromycin are widely used in clinical practice. However, comparative data regarding their efficacy and safety in Indian patients remain limited. The objective is to evaluate the age-specific efficacy of oral azithromycin in mild and moderate acne vulgaris. To evaluate the age-specific efficacy of oral doxycycline in mild and moderate acne vulgaris. Subjects and Methods: A prospective randomized parallel-group study was conducted in the Department of Pharmacology at Saraswathi Institute of Medical Sciences, Hapur, from March 2024 to February 2026. A total of 160 patients aged 15–25 years with mild to moderate acne vulgaris were included. Patients were divided into two groups based on disease severity (mild and moderate acne). Each group was further subdivided into four subgroups according to age and systemic antibiotic therapy. Subgroups receiving doxycycline were treated with oral doxycycline 100 mg once daily, while those receiving azithromycin were given oral azithromycin 500 mg three times weekly for six weeks. All patients received topical benzoyl peroxide 5% as adjunct therapy. Acne severity scores were recorded at baseline and at weekly follow-up visits for six weeks. Data were analysed using repeated measures ANOVA and independent sample t-test. Results: Both doxycycline and azithromycin produced a significant reduction in acne severity scores across all study subgroups over the six-week treatment period (p < 0.001). Doxycycline demonstrated slightly faster early improvement in inflammatory lesion counts, whereas azithromycin showed comparable efficacy by the end of the treatment period. Both drugs were well tolerated, and no serious adverse effects were reported. Conclusion: Both oral doxycycline and oral azithromycin are effective and safe options for the management of mild to moderate acne vulgaris. While doxycycline may produce a faster initial response, azithromycin pulse therapy provides comparable overall efficacy with good tolerability and may serve as a suitable alternative in selected patients.

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