Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 2257 (doi:10.1542/peds.2006-1701)

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LETTER TO THE EDITOR

Azithromycin for Pityriasis

Alejandro Clavier, MD
Department of Pediatrics

Jordan Hupert, MD
Department of Clinical Pediatrics
University of Illinois
Chicago, IL 60612

To the Editor.—

We read with interest the article "Azithromycin Does Not Cure Pityriasis Rosea"¹ by Amer and Fischer. We were pleased to see a follow-up study from the interesting results that Sharma et al² published in the Journal of the American Academy of Dermatology in 2000, in which 73% of patients with pityriasis rosea (PR) who were treated with erythromycin had complete resolution of lesions within 2 weeks compared with none in the placebo group. In this recent study, Amer et al concluded that a 5-day treatment with azithromycin did not modify the clinical course of PR. We feel that there are a few issues that warrant further consideration. One issue is that in the study, Amer and Fischer compared erythromycin to placebo. Although erythromycin and azithromycin are macrolides, there may be differences between them that make azithromycin less effective in the treatment of PR. More significantly, however, the absolute risk reduction (ARR) 95% confidence interval (CI) was wide enough to include a clinically significant effect of azithromycin. The ARR was 18% (95% CI: –9% to 46%), the upper limit of which does not exclude the investigators' own lower limit for effectiveness (30%). Notably, the CI is heavily skewed toward azithromycin effectiveness. A study of 100 patients (a similar number of patients as in the Sharma et al study [90 patients]) with results in similar proportions as reported by the current authors would yield a statistically significant ARR of 20% (0.8% to 39%). The current study's results did not exclude a clinically significant effect as defined by the authors.

REFERENCES

1. Amer A, Fischer H. Azithromycin does not cure pityriasis rosea. Pediatrics. 2006;117 :1702 –1705[Abstract/Free Full Text]
2. Sharma PK, Yadav TP, Gautam RK, Taneja N, Satyanarayana L. Erythromycin in pityriasis rosea: a double blind, placebo-controlled clinical trial. J Am Acad Dermatol. 2000;42 :241 –244[CrossRef][Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Clavier, A. Articles by Hupert, J. Search for Related Content PubMed PubMed Citation Articles by Clavier, A. Articles by Hupert, J. Related Collections Allergy & Dermatology Social Bookmarking                         What's this?