Clinical Efficacy of Azithromycin Versus Doxycycline in Patients of Acne Vulgaris
Comparative Efficacy of Azithromycin and Doxycycline in Acne Vulgaris
Abstract
Objective: To determine the clinical efficacy of azithromycin versus doxycycline in patients of acne vulgaris.
Methodology: A quasi-experimental study Was conducted at the Department of Dermatology, Dow University
of Health Sciences (DUHS), Karachi, from 09-07-2025 to 10-10-2025. The patients diagnosed with acne
vulgaris were randomly distributed into Group A (Azithromycin Group) and Group B (Doxycycline Group).
Group A patients were treated with oral azithromycin in a dose of 500 mg once a day and three times a week,
whereas patients in group B received oral doxycycline in a dose of 100 mg once a day. All patients were
additionally given 0.1% topical adapalene. Follow-up of each patient was performed after 6 weeks and 12
weeks, and improvement was measured after 12 weeks of therapy.
Results: Of the 122 patients with acne vulgaris, males were 36.1% (n=22) and 31.1% (n=19), and females
were 63.9% (n=39) and 68.9% (n=42) in the Azithromycin and Doxycycline groups, respectively. There was
no discernible difference between the two groups' levels of severity before treatment (p-value=0.917) and
after six weeks of treatment (p-value=0.994), while a significant difference is seen after twelve weeks of
treatment (p-value=0.018). Improvement in terms of clinical efficacy was significantly (p-value=0.006) higher
in the Doxycycline group than in the Azithromycin group.
Conclusion: The clinical efficacy of azithromycin and doxycycline was similar after six-weeks of treatment,
while doxycycline showed significantly higher clinical efficacy than azithromycin after twelve weeks of
treatment in the management of acne vulgaris.
References
Bhatt J, Kumar VJ, Chahat. Acne vulgaris: key insights, treatment, and future prospects. Mol Divers. 2025;1–36.
Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10:2021-8-6.
Alsaadoon NS, Al-Refaie AM, Habashy AY. Acne vulgaris in adolescents: a comprehensive review. Benha J Appl Sci. 2024;9(12):5–13.
Zhu Z, Zhong X, Luo Z, Liu M, Zhang H, Zheng H, et al. Global, regional and national burdens of acne vulgaris in adolescents and young adults aged 10–24 years from 1990 to 2021: a trend analysis. Br J Dermatol. 2025;192(2):228–237.
Lenuța GD, Dan V, Popescu IA, Pătrașcu AI, Halip IA, Mădălina M, et al. The epidemiology of acne in the current era: trends and clinical implications. Cosmetics. 2025;12(3):106.
Institute for Health Metrics and Evaluation. GBD 2019 cause and risk: acne vulgaris level 3 cause. Seattle (WA): Institute for Health Metrics and Evaluation; 2023.
Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–1222.
Masshadi SF, Zia A, Masood M, Ashfaq N. Psychosocial impact of acne vulgaris, its prevalence and associated risk factors in university students of Rawalpindi/Islamabad. Pak Armed Forces Med J. 2022;72(Suppl 4):S827–S831.
Santer M, Burden-Teh E, Ravenscroft J. Managing acne vulgaris: an update. Drug Ther Bull. 2024;62(1):6–10.
Eichenfield DZ, Sprague J, Eichenfield LF. Management of acne vulgaris: a review. JAMA. 2021;326(20):2055–2067.
Corcoran L, Muller I, Layton AM, Rucinski G, Venkatess V, Sufraz A, et al. Systematic review of clinical practice guidelines for acne vulgaris published between January 2017 and July 2021. Skin Health Dis. 2023;3(4):e240.
Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30.
Baldwin H. Oral antibiotic treatment options for acne vulgaris. J Clin Aesthet Dermatol. 2020;13(9):26–32.
Tobiasz A, Nowicka D, Szepietowski JC. Acne vulgaris: novel treatment options and factors affecting therapy adherence: a narrative review. J Clin Med. 2022;11(24):7535.
Arjel A, Pokhrel K, Sharma S. Efficacy of oral azithromycin versus doxycycline in the treatment of acne vulgaris. J Nepal Med Coll. 2020;18(2):59–62.
Sutaria AH, Masood S, Saleh HM, Schlessinger J. Acne vulgaris. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
Layton AM, Ravenscroft J. Adolescent acne vulgaris: current and emerging treatments. Lancet Child Adolesc Health. 2023;7(2):136–144.
Morshed AS, Noor T, Uddin Ahmed MA, Mili FS, Ikram S, Rahman M, et al. Understanding the impact of acne vulgaris and associated psychological distress on self-esteem and quality of life. Sci Rep. 2023;13(1):21084.
Ding R, He Y, Wu Q, Lin T. Quality of life in patients with acne vulgaris: an observational study. Int J Dermatol Venereol. 2024;7:e155–e182.
National Institute for Health and Care Excellence. Acne vulgaris: management. London: National Institute for Health and Care Excellence; 2023.
Raees T, Ali A, Ahmed S, Tayyab M, Munir A, Lodhi S. Unmasking acne: azithromycin edges out doxycycline in randomized trial at a tertiary care centre. J Islamabad Med Dent Coll. 2024;13(2):257–264.
Iqbal F, Alam MA, Tahir M, Qasim M, Ansar M, Mustafa SH. Efficacy of oral azithromycin and oral doxycycline in patients with acne vulgaris. Pak J Physiol. 2023;19(2):25–27.
Carmina E, Dreno B, Lucky AW, Agak GW, Dokras A, Kim JJ, et al. Female adult acne and androgen excess: a report from the multidisciplinary Androgen Excess and PCOS Committee. J Endocr Soc. 2022;6(3):bvac003.
Amatya A, Chaudhary MK, Khan DK, Rajouria EA. A comparative study of azithromycin versus doxycycline in the treatment of acne vulgaris. Nepal J Dermatol Venereol Leprol. 2012;10(1):33–40.
Copyright (c) 2026 Annals of Jinnah Sindh Medical University
This work is licensed under a Creative Commons Attribution 4.0 International License.
