Azithromycin Pulses for the Treatment of Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption: An Effective and Convenient Alternative to Tetracyclines

Background: Papulopustular eruption (PPE) is the most common cutaneous side effect of epidermal growth factor receptor inhibitors (EGFRIs). Objective: To document the efficacy and safety of pulsed azithromycin doses in the treatment of EGFRI-related PPE. Methods: A retrospective analysis of patients under EGFRIs who exhibited at least grade 2 PPE and were intolerant or resistant to tetracyclines was performed. Treatment consisted of pulsed azithromycin doses of 500 mg daily for 3 consecutive days per week for at least 2 weeks. Results: Treatment with azithromycin showed a significant reduction in the number of lesions in 18/20 patients, with 11 showing complete resolution of the rash. No significant side effects were recorded. We did not observe any interactions with the targeted biological agents or any obvious compromise of the anticancer treatment. Conclusions: Weekly pulses of azithromycin are effective and promote increased patient adhesion to the treatment. A prospective study is needed to confirm efficacy and safety of this convenient treatment.