Avoiding Antibiotic Resistance in Acne Treatment
Antibiotic resistance has implications for treating infections ranging from pneumonia to acne. Propionibacterium acnes (P acnes) is a bacteria that plays a role in the pathogenesis of acne. Typically, dermatology providers prescribe topical erythromycin and clindamycin and oral tetracyclines, which are bacteriostatic (that is, they inhibit bacterial growth) versus bactericidal (kills bacteria). Because bacteriostatic agents don’t kill the bacteria, the bacteria retain the potential to become resistant, thus potentially increasing the number of antibiotic-resistant strains of P acnes.
A recent summary of the clinical findings known about antibiotic resistance in acne treatment was published in JAMA Dermatology. The findings state that the common use of antibiotics for acne is associated with development of resistance in P acnes. Some of the effects of this resistance include a reduction in the clinical efficacy of topical erythromycin, severe infections related to resistant strains of P acnes, and resistance that may persist after discontinuation of therapy. This resistance is of concern because the use of antibiotics for acne could lead to off-target effects such as resistance to Staphylococcus aureus. In addition, in one study of patients treated with topical and/or oral antibiotics for acne, patients were significantly more likely to develop upper respiratory infections during 1 year of follow-up than patients who had not received antibiotics.
These myriad findings suggest the need for promoting antibiotic stewardship to treat acne to avoid creating an environment for antibiotic resistance. Resistance reduction strategies include:
• Avoid antibiotic monotherapy. For mild-to-moderate acne, first-line treatment is with Benzoyl Peroxide (BP), topical retinoids, or combination therapy, which may incorporate a topical antibiotic with either BP or retinoids.
• For moderate-to-severe acne, first-line treatment is with oral antibiotics combined with BP and a topical retinoid.
• Limit the duration of oral antibiotic use.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: August 31, 2017
Source: JAMA Network
Adapted from the original article.