Intravenous ertapenem for hidradenitis suppurativa

Evidence Rating Level: 2 (Good)​

Study Rundown: Hidradenitis suppurativa (HS) is a chronic dermatological condition characterized by painful pustules, nodules, abscesses, tunnels, and scarring in apocrine gland-bearing regions. HS is associated with decreased quality of life, including depressive symptoms. Current treatments include antibiotics (topical, oral, and intravenous [IV]), antiandrogen therapy, and immunomodulators. For recalcitrant cases, surgical deroofing and excision may be performed. Although oral antibiotics are generally accepted as a therapeutic approach for HS, little evidence has explored IV antibiotics such as ertapenem. Therefore, this retrospective cohort study investigated the optimal duration, efficacy, and patient satisfaction of IV ertapenem therapy for HS. Of 98 patients, IV ertapenem for HS was associated with clinical, inflammatory marker, and patient satisfaction improvement. Limitations of this study include a single-institution population, lack of a control group, incongruent follow-up times, retrospective design, and potential recall bias. ​

Click to read the study in JAMA Dermatology

Relevant Reading: Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients

In-Depth [retrospective cohort]: Data included in this study was obtained from 98 patients (mean [SD] age, 35.8 [13.0] years; 61 [62.2%] female) who had a diagnosis of HS treated with IV ertapenem at the Montefiore HS Centre between January 1, 2018 and July 1, 2022. Patients only received IV ertapenem for intractable cases of HS despite ongoing management with other treatment modalities. Exclusion criteria included patients who did not have follow-up visits after ertapenem discontinuation. IV ertapenem, 1 g daily for 12-16 weeks, was self-administered athome. Patients continued antiandrogen and immunomodulatory biologic therapies medicationsthat they were receiving baseline; however, oral antibiotics were discontinued. The primary outcomes of this study included clinical severity, pain, markers of inflammation, bacterial abundance, and patient satisfaction. Clinical severity was assessed through the HS Physician Global Assessment score, a 6-point scale ranging from clear to very severe. Pain was evaluated on an 11-point scale from no to worst possible pain. Markers of inflammation and bacterial abundance were measured at baseline, midcourse of IV ertapenem treatment, end of IV ertapenem treatment, and post-treatment. Specifically, these markers included leukocytes, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6. Lastly, patient satisfactionwas assessed during follow-up. The mean (SD) IV ertapenem treatment duration was 13.1 (4.0) weeks, with follow-ups posttherapy occurring after 7.8 (3.6) weeks. HS Physician Global Assessment scores at baseline and posttherapy follow-up were 3.9 [1.0] vs 2.7 [1.2]; P < .001, respectively. Reductions from baseline to posttherapy were also seen for pain (4.2 [3.3] vs 1.8 [2.7]; P < .001), C-reactive protein (5.4 [11.4] vs 2.4 [2.0] mg/dL; P < .001), interleukin-6 (25.2 [21.1] vs 13.7 [13.9]; P < .001), and leukocytes (11.34 [3.9] vs 10.0 [3.4]; P < .001). Of 76 patients participating in the telephone survey, 63 (80.3%) reported medium to high satisfaction, and 69 (90.8%) reported they would recommend IV ertapenem treatment. Overall, IV ertapenem for HS was associated with clinical inflammatory markers and improved patient satisfaction.

Image: PD

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