Antibiotic Resistance in Acne

Global Antibiotic Resistance

Acne Vulgaris continues to be a common skin condition that we see in daily practice. Increasingly, we have noticed a worrying trend that many individuals do not respond to antibiotics, whether topical or oral antibiotics for acne. Antibiotics have been one of the most effective treatments for acne vulgaris over the past few decades, however resistance patterns have emerged worldwide.

Skin Propionebacterium acnes, a bacteria that normally colonizes the skin, is one of the factors implicated in the formation of acne. One of the cornerstones of acne treatment have been to reduce the bacterial load and inflammation. Recent studies have shown that prevalence of resistant strain to antibiotics have increased from 34.5% in 1991 to a peak of 64% in 1997.

Resistance to the antibiotic Erythromycin was the most common. In individuals who were resistant to erythromycin, they have a high probablilty of being cross-resistant to Clindamycin, another commonly prescribed antibiotic. Resistance to the tetracycline class of antibiotics (e.g. doxycycline) have remained low, but this may change in the future.

How Do We Combat The Resistance?

To improve the outcomes in acne treatment and reduce antibiotic resistance, we recommend the following:

1. Topical acne creams that have an antibiotic as an ingredient should be combined with a retinoid and/or benzoyl peroxide to reduce resistance.
2. Oral antibiotics should only be used for the shortest period of time possible, and only for moderately-severe acne vulgaris.
3. Avoid combining different classes of antibiotics in the treatment regime i.e. an oral antibiotic combined with a different topical antibiotic cream
4. Stop the antibiotic based treatment if there is no significant improvement in your acne. There are now many safe and effective treatment options for acne available.
5. Oral antibiotic therapy should always be combined with topical retinoid and/or benzoyl peroxide based cream to reduce resistant strains from emerging.
6. For maintenance therapy, use a topical retinoid and/or benzoyl perozide, instead of an antibiotic.

References:

1. Patel M, et al. The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: a review. J Drugs Dermatol 2010;9:655-664
2. P Coates, et al. Prevalance of antibiotic-resistance propionibacteria on the skin of acne patients: 1--year surveillance data and snapshot distribution study. British J of Dermatology. 2002;146(5):840-848