Differential Rates of Vulvovaginal Candidiasis Across Oral Antibiotic Use for Acne Treatment: A Large Database Retrospective Review Using TriNetX [ID 1157]

INTRODUCTION: Oral tetracyclines and macrolides are commonly used for treating moderate-to-severe acne but can predispose patients to vulvovaginal candidiasis (VVC). Limited literature analyzes differential risks of oral antibiotics in VVC; we aim to bridge this gap. METHODS: Deidentified medical records were analyzed using TriNetX platform from 69 U.S. health care organizations. Females diagnosed with acne were designated into exclusive treatment cohorts: doxycycline (n=89,233), minocycline (n=30,936), azithromycin (n=15,924), and erythromycin (n=3,161). A control cohort included females with acne who had not received these antibiotics. Pregnant, diabetic, or HIV/AIDS patients were excluded as confounding factors. Comparative analyses studied Cox hazard ratios (HRs), with 95% CIs, of VVC up to 6 months post-treatment. The ICD diagnosis of VVC was cross-referenced with the presence of Candida DNA/RNA in vaginal fluid via probe detection. Cohorts were matched for age, ethnicity, race, and gender using a propensity score model. RESULTS: The risk comparison after propensity matching revealed that azithromycin and doxycycline showed a significantly higher incidence of VVC compared to the control cohort with HR 2.349 (1.928, 2.862) and HR 1.239 (1.129, 1.359), respectively ( P <.0001). Azithromycin also showed a significantly higher incidence of VVC than doxycycline, with HR 1.662 (1.396, 1.98; P <.0001). Erythromycin and minocycline did not show a significantly higher incidence than the control with HR 1.355 (0.814, 2.257) and HR 1.08 (0.908, 1.285), respectively. CONCLUSIONS/IMPLICATIONS: Azithromycin and doxycycline confer a significant risk of developing VVC 6 months post-treatment, with azithromycin conferring the highest risk. This can guide decision making when prescribing oral antibiotics for acne treatment.