Comparison of Efficacy and Safety of Low-dose Versus High-dose Oral Azithromycin in the Treatment of Moderate Acne Vulgaris


  • Ploysyne Rattanakaemakorn Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol Unviersity
  • Ya-Nin Nokdhes Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol Unviersity
  • Ploychompoo Srisuwanwattana Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol Unviersity
  • Thanya Techapichetvanich Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol Unviersity


Azithromycin, Acne


Background: The efficacy of oral azithromycin in the treatment of inflammatory acne vulgaris has been established in some open-label clinical studies. However, the optimal dose and duration of azithromycin has not been clearly defined. Objectives: To compare the efficacy and tolerability of low-dose versus high-dose oral azithromycin in the treatment of moderate acne vulgaris. Materials and Methods: In this investigator-blind, randomized, comparative study, 20 patients with more than 10 inflammatory acne papules were randomized into two groups. The low-dose group received 6 g of oral azithromycin in 10 weeks while the high-dose group received 12 g in 8 weeks. All patients were allowed to apply only topical 0.1% adapalene gel once a day. Inflammatory lesion counts and side effects were recorded at baseline, 4 weeks and the last week of azithromycin use in each group. The overall satisfaction, compliance and adverse drug reactions were evaluated in all subjects. Results: At the end of treatment, the mean percentage reduction of inflammatory lesions was 87.7±19.6 and 65.7±26.8 in the low-dose and high-dose group, respectively. However, no statistically significant difference was found between both groups. In terms of side effects, four patients in the high-dose group had diarrhea but it did not occur in the low-dose group. Patients satisfaction were comparable in both groups as most of the patients rated as “moderate improvement”. Conclusion: In this randomized control trial, there was no statistical difference in terms of treatment outcome for moderate acne vulgaris between low-dose and high dose azithromycin. However, our results suggest that low-dose azithromycin had less side effects, less cost and more simple to administer when compared to high-dose azithromycin.


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How to Cite

Rattanakaemakorn, P., Nokdhes, Y.-N., Srisuwanwattana, P., & Techapichetvanich, T. (2018). Comparison of Efficacy and Safety of Low-dose Versus High-dose Oral Azithromycin in the Treatment of Moderate Acne Vulgaris. Thai Journal of Dermatology, 34(2), 130–142. Retrieved from



Original articles