Which is More Effective for Acne Treatment: Spironolactone or Antibiotics?

Spironolactone, a versatile drug used to treat low potassium levels and high blood pressure among other conditions, is being touted as a successful alternative to antibiotics for acne treatments in females, according to a retrospective study recently published in the Journal of the American Academy of Dermatology.

Antibiotic overuse and microbial drug resistance continues to be a concern in severe acne treatment. One 2015 study found that 137 patients were prescribed oral antibiotics for 11 months before their physicians realized that the drugs weren’t effective and transitioned them onto isotretinoin. The researchers from the department of dermatology at the University of Pennsylvania are calling spironolactone a possible “first-line agent before oral antibiotics.”  

The UPenn researchers analyzed data from 2010 to 2016 in the Optum Clinformatics Data Mart that featured female patients who were prescribed at least 12-month courses of spironolactone or oral antibiotics.

In the database, there were 4,321 patients taking spironolactone and 7,517 using oral tetracycline-class antibiotics. The researchers found that the spironolactone treatment plans had a much longer duration than the antibiotic prescriptions, however some of these patients might have discontinued antibiotic use because many guidelines recommend a usage period of three to six months. After taking into account factors such as the patients’ age at diagnosis, history of polycystic ovarian syndrome, and history of oral contraceptive or topical retinoid use, they determined that their hazard ratio for quitting spironolactone treatment was 0.74, compared with treatment for oral tetracyclines.

The healthcare community is still learning about the long-term effects of spironolactone and how it compares with other possible treatment plans. However, these researchers are ultimately supportive of its acne-fighting properties: “The extended drug usage survival of spironolactone suggests that, in routine clinical practice, spironolactone may have good long-term effectiveness and tolerability,” they wrote.