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Dermatology

Antibiotic use for acne reducing effectiveness elsewhere, says leading dermatologist

Antibiotics should not be used for acne because they are ineffective and contributing to resistance.

Large surveys from 1976-1996 showed that up to 62% of Propionibacterium acnes isolates were resistant to antibiotics

Source: Ocskay Bence / Dreamstime.com

Large surveys from 1976-1996 showed that up to 62% of Propionibacterium acnes isolates were resistant to antibiotics

Widespread prescription of antibiotics to treat acne could be contributing to the development of resistant bacteria elsewhere in the human biome, a consultant dermatologist told colleagues at a recent British Association of Dermatologists conference.

Speaking at the meeting in Glasgow, Keith Freeman said the use of antibiotics to treat acne is poorly supported by available evidence and should be phased out within ten years.

Freeman said about 8% of all antibiotics prescribed in the UK are for dermatological indications and could be contributing to the growing number of resistant organisms. He said part of the problem was the long periods for which antibiotics are prescribed.

Current European guidelines advise against the use of topical or systemic antibiotic monotherapy for acne. Systemic antibiotic therapy in combination with a topical (non-antibiotic) agent for 12 weeks receives only a medium-strength recommendation.

Large surveys from 1976-1996 showed that up to 62% of Propionibacterium acnes isolates were resistant to erythromycin, clindamycin and tetracycline so that treatment was unlikely to be effective.

But, while bacteria causing acne do not always respond to antibiotics, Freeman says bacteria elsewhere in the body, for example in the gut, could be developing resistance. Clindamycin and doxycycline, two antibiotics commonly recommended in acne treatment, are first-line treatments for Meticillin-resistant Staphylococcus aureus. Indiscriminate use for acne treatment could limit their efficacy in future.

Freeman called for robust antibiotic stewardship and recommended a treatment scheme for acne that would use little or no antibiotics. He suggested that the use of topical antibiotics should be discontinued and that courses of systemic antibiotics for acne treatment should be shortened.

Freeman recommended that mild acne should be treated with a combination product containing adapalene and benzoyl peroxide (Epiduo). Moderate acne could be treated with Epiduo and either lymecycline for 6–12 weeks or low-dose (40mg), modified-release doxycycline. (At this dose doxycycline has no antibiotic activity but exerts an anti-inflammatory action.) Epiduo could then be used for maintenance treatment, he suggested. Severe acne should be treated with isotretinoin.

There is no guideline from the National Institute for Health and Care Excellence on acne, only clinical knowledge summaries. An evidence-based guideline was produced by the European Dermatology Forum in 2011.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065860

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