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  • Brindley Brooks

Antibiotics for HS: Why They Do & Don't Work

Article Medically Reviewed by Ashley Biscoe, ND, MPH

Naturopathic Doctor and Co-Owner of Attune Functional Medicine & Help for HS


Antibiotics currently serve as one of the pillars of treatment for HS. As advocates, we want to be sure you are fully educated so you can make the decision for yourself and your personal HS.

Antibiotics may be beneficial for some due to their antimicrobial and anti-inflammatory properties if they are used properly and strategically. However, antibiotics should not be the sole therapy for HS. They are not a one-size fits-all treatment. Please review your medical history with your physician, and let them know about any antibiotics you have used in the past.


Please understand that the overuse of antibiotics does not come without risk.


In the past, antibiotics were primarily given because it was believed that HS was a form of acne. Unless you have an actual infection, antibiotics are usually being prescribed to try to reduce inflammation or as an antimicrobial treatment. However, in many cases, the antibiotic is prescribed without a culture or any confirmation that bacteria are present.


Typically HS abscesses are not the result of an infection. This does not mean that abscesses cannot become infected, but HS is not an infectious disease.


A common scenario for those treated with antibiotics for HS is that you seem to get better in the beginning, but then your HS starts to come back, usually with a vengeance. It has been explained by some specialists that you may see initial improvement if bacteria microorganisms were initially present and the antibiotic resolved that bacteria. Another reason for the initial improvement is that many antibiotics have powerful anti-inflammatory and immunomodulatory effects. This means antibiotics can act on the immune system and reduce inflammation apart from their anti-microbial effects. For this reason, dermatologists commonly use antibiotics for non-infectious conditions.


There are some doctors who prescribe two or three different kinds of antibiotics at a time (such as a combination of Clindamycin and rifampicin) or prescribe a very strong antibiotic (Bactrim for example), which has the same effect described above. Typically you’re moved to a different class of antibiotic and this cycle continues until (in many cases) antibiotic resistance happens. Antibiotic resistance occurs when bacteria change in response to the use of antibiotics. It is the bacteria - not you - that have become resistant. Some people eventually develop allergies, intolerance or other serious reactions to antibiotics over time, making the antibiotics unsafe or completely ineffective.The issue with this is the potential for antibiotic resistance to develop. If you ever develop chronic staph infections and/or MRSA, you do not want to have antibiotic resistance to antibiotics because it could create a serious or life-threatening situation.


Resistance & Complications


Antibiotic resistance occurs when the germs (bacteria) no longer respond to the antibiotics designed to eliminate them; this means the germs are not controlled and continue to grow.


A common misconception is that a person's body becomes resistant to specific antibiotics; however, it is the bacteria that become resistant, not the person. Antibiotic resistance can occur naturally. However, each time you take an antibiotic unnecessarily or improperly, you increase the chance of developing medicine-resistant bacteria. Bacteria are constantly finding new ways to avoid the effects of antibiotics.


Taking antibiotics only when necessary is one way you can protect yourself from antibiotic resistance. Using caution and moderation with antibacterial soaps (especially if they contain “triclosan”) is also important.


Some antibiotics such as minocycline have been known to cause drug-induced lupus. Many scientists believe that taking long-term antibiotics can come with a range of problems associated with glucose metabolism, the immune system, and food digestion. Antibiotics also promote the growth of fungus because they kill the body’s beneficial bacteria that would normally keep fungus in check. Having too much fungus in the body can lead to problems such as vaginal yeast infections, jock itch, fungal toenail infections, headaches, fatigue, digestive issues, and even skin problems. In fact, researchers are now investigating the possible role of fungus in HS.


Chronic Infections


While it is not common, some HS sufferers develop chronic infection such as MRSA (Staph). These infections don't necessarily have to occur within HS abscesses; these individuals are simply prone to infections. In these cases, long-term antibiotics may be appropriate. Such individuals must take these antibiotics to avoid life-threatening situations.


Note: In the UK, various antibiotic options such as Clindamycin/Rifampcin have to be tried first, per national treatment guidelines, before a person can be considered for biologic treatments such as Humira.


Antibiotic Concerns


Fluoroquinolone type antibiotics should be reserved for use in patients with conditions who have no alternative treatment options.


The FDA is strengthening its warning regarding fluoroquinolones as they have been linked to sudden, serious, and potentially permanent nerve damage called peripheral neuropathy, along with other serious health complications. Peripheral neuropathy is damage to the nerves that send information to and from the brain and spinal cord and the rest of the body. It can also cause long-lasting, disabling and potentially permanent side effects involving tendons, muscles, joints and the nervous system. Other side effects include inflamed or torn tendons, muscle pain or weakness, joint pain or swelling, walking difficulty, feelings of pins and needles, burning pain, tiredness, depression, problems with memory, sleeping, vision, hearing, altered taste and smell, pain in the arms or legs, and gait disturbance. Tendon swelling and injury may occur within just 2 days of starting treatment with a fluoroquinolone, but may even occur several months after stopping treatment.


More than 23 million patients received a prescription for one of these medications in 2011 alone including:

  • Ciprofloxacin (Cipro)

  • Gemifloxacin (Factive)

  • Levofloxacin (Levaquin)

  • Moxifloxacin (Avelox)

  • Norfloxacin(Noroxin)

  • Ofloxacin (Floxin)

Article about the anti-inflammatory and immunomodulatory effects of various antibiotics:




Articles regarding the role of fungus in HS:




Antibiotic resistance and side effect information references:

Johns Hopkins medicine

Scientific America

CDC

WHO (World Health Organization)

Catharine Paddock, Ph.D.


Read about other treatment options here.


hsconnect.org


Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.


Written by Denise Panter-Fixsen

Edited by Brindley Kons

Medically Reviewed by Ashley Biscoe, ND, MPH


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