Treatment - Antibiotics

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Hidradenitis suppurativa (HS) is a chronic, painful inflammatory skin disease with a heavy impact on the quality of life. The disease begins when clogged hair follicles cause bumps. In sporadic flares, symptoms worsen.1

Repeated or long-term treatment with antibiotics helps prevent HS symptoms from flaring or getting worse. Doctors recommend antibiotics that are:2

  • Active against bacteria most commonly found in HS lesions (sores)
  • Effective against biofilms (bacteria that stick to each other and other surfaces, such as hair follicles and sinus tracts)
  • Anti-inflammatory
  • Able to reduce the immune response

How do antibiotics work?

Antibiotics kill bacteria or stop them from growing and multiplying. Antibiotics only work to treat certain types of bacterial infections, like strep throat, bronchitis, and urinary tract infections. Different antibiotics work against different kinds of bacteria. Antibiotics do not work on viral infections.3

Some antibiotics are taken by mouth (orally). Others are given through an IV or an injection.

Examples of antibiotics for HS

HS does not have 1 best antibiotic treatment. Your doctor will prescribe antibiotics based on the severity of your condition and your needs.1,4

The most commonly prescribed antibiotics for HS include:1,4-6

  • Tetracyclines (tetracycline, doxycycline, minocycline, tigecycline)
  • Clindamycin combined with rifampin
  • Moxifloxacin-metronidazole-rifampin combination
  • Dapsone
  • Ertapenem

Other antibiotics benefit some people with HS, but more research is needed to support recommendations.7,8

Tetracyclines for HS

Tetracyclines are a class of antibiotics that are often used to treat acne and skin infections. Research shows that oral tetracycline improves mild to moderate HS symptoms by about 30 percent.7,8

Clindamycin combined with rifampin for HS

Clindamycin and rifampin are often used to treat inflammation. They are oral antibiotics that are used together to treat severe HS symptoms. They are also used when a tetracycline antibiotic does not work in people with mild to moderate HS.2,7,8

Researchers have studied treatment with this combination more than most other antibiotics. Using this treatment for 10 weeks, studies have shown that the combination reduces disease. Some people with HS had complete remission.2,7,8

Moxifloxacin-metronidazole-rifampin combination for HS

Moxifloxacin, metronidazole, and rifampin together have been proven to be effective in people with moderate to severe HS that did not respond to other treatments. This combination is used as a bridge to surgery or other long-term therapy.7,8

In one study, some people achieved complete remission. Treatment lasted up to 12 weeks. Metronidazole was stopped after 6 weeks to avoid nerve damage. Relapse was common, but most people responded to a second course of treatment.7,8

Dapsone for HS

Dapsone is an anti-inflammatory antibiotic that may be a long-term maintenance treatment for a small number of people with mild to moderate HS when other treatments fail. To prevent relapse, continuous therapy is needed.7,8

Ertapenem for HS

Ertapenem is another antibiotic that may help treat HS. It can be given through an IV or an injection. Studies on ertapenem have shown it may improve HS symptoms in severe cases. It can be used as a long-term treatment to control symptoms. It also may help as a one-time treatment between surgeries or to relieve very serious symptoms.6,7

What are the possible side effects of antibiotics?

Side effects can vary depending on the specific drug you are taking. Common side effects of antibiotics include:3

  • Diarrhea, nausea, or vomiting
  • Headaches
  • Rash
  • Yeast infections

In some cases, some antibiotics can cause serious side effects, including:3-7

  • C. diff infections, which causes diarrhea that can lead to severe damage to the colon and death
  • Severe and life-threatening allergic reactions
  • Kidney and liver problems

These are not all the possible side effects of antibiotics. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking antibiotics.

Other things to know about antibiotics

Sometimes, bacteria respond to antibiotics by changing (mutating) so the drug no longer kills or weakens them. This is called antibiotic resistance. As antibiotic resistance develops, stronger doses of the same antibiotic or different antibiotics are needed to get the same results.3

Antibiotics are just 1 part of HS treatment. Other approaches may include different drugs, surgery, diet and lifestyle changes, and alternative medicine.

You should discuss the risks and benefits of antibiotics with your doctor, as well as any other steps you should take to avoid side effects.

Before taking any antibiotics, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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