To improve the outcomes in acne treatment and reduce antibiotic resistance, we recommend the following: Topical acne creams that have an antibiotic as an ingredient should be combined with a retinoid and/or benzoyl peroxide to reduce resistance.
How can we prevent antibiotic resistance in the treatment of acne?
Limiting the frequency and duration of antibiotic use and adding the topical antimicrobial agent BPO will minimize the development of resistance while maintaining efficacy in the treatment of inflammatory and non-inflammatory acne lesions.
Is there a new antibiotic for acne?
But the truth is, there hasn’t been a new antibiotic for acne since daptomycin was launched in the late 1980s.
Do antibiotics cause acne?
A 2010 study in the Journal of the German Society of Dermatology found that more than half of acne patients in Europe treated with antibiotics harbored bacteria that were resistant to at least one antibiotic.
How long should you use antibiotics for acne?
A 2015 article in the Journal of the American Academy of Dermatology noted that current guidelines recommend limiting antibiotic use to a maximum of three months. The authors stated, "Expert guidelines recommend responsible use of antibiotics in acne in light of emerging resistance.
How can you prevent antibiotic resistance in acne?
To facilitate limiting oral antibiotic courses to 3 or 4 months, patients should continue BP and topical retinoids as maintenance therapy after stopping oral antibiotics. The EADV recommends combining oral antibiotics with topical retinoids, fixed-dose topical retinoid/BP or azelaic acid for moderate-to-severe acne.
Can acne treatment lead to antibiotic resistance?
The use of antibiotics to treat severe acne can lead to the development of antibiotic resistance in the bacteria that cause the skin condition, say researchers from the Karolinska Institute in Stockholm, Sweden.
How do you reverse antibiotic resistance?
Four bacterial defences against antibioticsInvisibility cloak. The bacterial organism changes its physiology so that the antibiotic cannot find its target. ... Pump and flush. Bacteria regularly expel harmful compounds from their system using a protein to pump it out of the cell. ... Protein shield. ... Counterattack.
What is the best way to prevent bacteria from becoming antibiotic resistant?
Ways to prevent antibiotic resistanceMinimise unnecessary prescribing and overprescribing of antibiotics. ... Complete the entire course of any prescribed antibiotic so that it can be fully effective and not breed resistance.Practise good hygiene such as hand-washing and use appropriate infection control procedures.
Does benzoyl peroxide cause bacteria resistance?
Benzoyl peroxide is one of the safest and most effective treatments for inflammatory lesions and is usually used in mild to moderate acne as a first-line therapy. It works as an antimicrobial, against P. acnes, although it does not cause bacterial resistance.
Does acne return after doxycycline?
After you stop taking doxycycline, you still have treatment and your acne won't come back. You only need to take doxycycline for a short time (which reduces the chance that P. acnes will become resistant to doxycycline)
Can we beat antibiotic resistance?
You can work to avoid becoming resistant to antibiotics by trying to prevent infections and practicing regular handwashing. You can help combat antibiotic resistance by asking your doctor if an antibiotic is necessary in the event that they suggest taking one, Adalja said.
Does antibiotic resistance go away over time?
Without the selective pressure of antibiotics killing off the competition, bacteria with this mutation should disappear over time. But when the genes responsible for resistance can also be swapped between cells, the equation gets more complicated.
How can I increase antibiotics in my body?
Seven best natural antibioticsGarlic. Cultures across the world have long recognized garlic for its preventive and curative powers. ... Honey. Since the time of Aristotle, honey has been used as an ointment that helps wounds to heal and prevents or draws out infection. ... Ginger. ... Echinacea. ... Goldenseal. ... Clove. ... Oregano.
How can you reverse antibiotic resistance naturally?
Food ingredients and nutrients such as thyme, mushrooms, ginger, garlic, sage, zinc, echinacea, elderberry, andrographis and pelargonium are examples of natural remedies that have been demonstrated to enhance immunity.
Why is antibiotic resistance a global problem?
Antibiotic resistance is a serious global problem because: When bacteria become resistant to an antibiotic, that antibiotic becomes less effective and less able to treat the condition for which it was prescribed, and also any other future bacterial condition that might arise.
How can antibiotic resistance be transferred?
Antibiotic resistant bacteria can easily be transferred from one person to another simply through touch.
How many people completed the survey on acne?
A 2019 article in The Journal of Clinical and Aesthetic Dermatology published the results of a survey that included acne patients and parents of teen acne patients. A total of 1919 participants completed the survey. The researchers found that most participants had a general understanding of antibiotic resistance, but that younger people tended to take the potential risks too lightly. 11
Why are antibiotics used sparingly?
Because antibiotics produce only limited results, and because their overuse presents such a danger to the patient and larger society, many doctors are now warning that antibiotics should be drugs of last resort , especially in acne treatment , a nd when they are used, they should be used sparingly and only for short periods of time (maximum 3 months).
What happens when you take antibiotics for long periods of time?
Treatment with antibiotics, especially over long periods of time, leads to antibiotic resistance. Antibiotic resistance means that bacteria become immune to the effects of antibiotics, and eventually the antibiotics can no longer kill the bacteria. Antibiotic resistance is a serious global problem because:
Why are antibiotics bad for you?
Oral antibiotics are a large part of the problem because once swallowed, they eliminate many groups of bacteria, which can cause many different strains of bacteria to become resistant. 9
What are the drawbacks of a syringe?
These drawbacks include a wide variety of side effects, which range from mild skin irritation and stomach upset, to permanent tooth and skin discoloration or life-threatening diarrhea.
What antibiotics are used for acne?
For first-line treatment of moderate-to-severe acne, the AAD recommends oral antibiotics (specifically doxycycline and minocycline, which have antimicrobial and anti-inflammatory effects) combined with BP and a topical retinoid. Topical antibiotics are also permissible, provided practitioners prescribe BP concomitantly. To facilitate limiting oral antibiotic courses to 3 or 4 months, patients should continue BP and topical retinoids as maintenance therapy after stopping oral antibiotics.
Is antibiotic resistance a dermatologist issue?
The issue of antibiotic resistance is pertinent not only to dermatologists, but also to general, medical and family practitioners who treat acne, said co-author Brandon L. Adler, M.D. He is a second-year dermatology resident (PGY-3) at the University of Southern California Keck School of Medicine.
Is topical antibiotic monotherapy discouraged?
1,2 "The official stance of major Academies of dermatology in the United States and Europe is that monotherapy with either topical or oral antibiotics is strongly discouraged because the available evidence shows that there's a trend toward resistance among Propionibacterium acnes and possibly off-target effects" such as increased antibiotic resistance among Staphylococcus aureus associated with topical antibiotics, 3 said Dr. Adler.
Can you use more than one topical antibiotic for acne?
There are excellent combination products available that incorporate a topical antibiotic with benzoyl peroxide. This makes it much easier for both the practitioner and patient" to use more than one topical agent simultaneously.
Why are antibiotics used for acne?
Years ago antibiotics were used to treat acne because it was thought that the condition was an infectious disease , says Dr. Hilary Baldwin of the Rutgers Robert Wood Johnson Medical School in New Jersey. However, it is now realized that while Propionibacterium (P) acnes is implicated in the pathophysiology of the condition by producing an ...
Why don't dermatologists recommend benzoyl peroxide?
But as patients don’t like benzoyl peroxide because it bleaches fabric, dermatologists don’t recommend it because they don’t want to be faced with patients annoyed that their sheets and pillowcases have become stained, she says.
How long does it take for clindamycin to lose effectiveness?
Topical clindamycin loses effectiveness after about two months unless it is combined with benzoyl peroxide, she explains. “Benzoyl peroxide reduces the development of resistant organisms when used in conjunction with either topical or oral antibiotics, so if you are going to use clindamycin, in my opinion, it ought to be in the tube along with the benzoyl peroxide.”
How many dermatologists write antibiotics?
Dermatologists make up less than 1% of U.S. physicians, but they write 5% of all scrips for oral antibiotics. “In my experience, perhaps less than 50% [of dermatologists] have bought into the concept that they are part of the problem, so it’s still an uphill climb to really convince people that although antibiotics make people better in the long run, they are doing us a harm,” she says.
What is the best medicine for a woman with a sex problem?
For women, she suggests trying spironolactone and oral contraceptives. However, spironolactone has antiandrogen effects, so she recommends early use of isotretinoin.
Should acne patients be given retinoids?
Regardless of what other treatments they are receiving, every acne patient should be using a retinoid, Dr. Baldwin adds. “A lot of non-dermatologists try to treat acne without the topical retinoids and it just doesn’t work. Everybody needs to be treated with a topical retinoid to unclog the follicles and to reduce the pre-pimples.”
Which drugs did not perform well in phase 3 trials?
Two other drugs which had appeared promising – a topical sebum inhibitor and a nitric oxide gel – did not perform well in phase three trials, she says.
What are the main causes of acne vulgaris?
There are four primary pathogenic factors: excess sebum production, bacterial colonization, inflammation, and abnormal keratinization. 1 Treatment targets as many pathogenic factors as possible and may include a combination of topical and systemic agents.
How much doxycycline should I take for acne?
Doxycycline is a secondgeneration tetracycline class antibiotic normally used at a dose of 100 mg to 200 mg/day in the treatment of acne. Skidmore randomized 51 patients with moderate acne to twice daily 20 mg doses of doxycycline or placebo for 6 months. 39 Active treatment significantly reduced the number of inflammatory and non-inflammatory lesions by more than 50% and led to a greater overall improvement compared to placebo, with no change in number or severity of resistant pathogens or evidence of antimicrobial effect on the skin flora. Toossi and colleagues compared subantimicrobial doses (20 mg twice daily) with antimicrobial doses (100 mg daily) in a prospective, double-blind, randomized controlled trial of 100 patients with moderate facial acne. 40 Both treatments significantly decreased inflammatory lesion counts; subantimicrobial dosing led to an 84% and 90% reduction in the number of papules and pustules, respectively. Although more rigorous trials designed to study the impact on follicular and cutaneous microflora and resistance patterns are warranted, these early results are promising and may represent a future possibility for the management of acne vulgaris.
Is acne a bacterial infection?
Acne does not represent a typical bacterial infection , in which antibiotic resistance directly correlates to treatment failure, because antibiotics demonstrate both antibacterial and anti-inflammatory effects, and P. acnes – existing in the microaerophilic or anaerobic and lipid-rich environment of the pilosebaceous follicle – cannot easily be cultured. However, it is logical to assume that resistance manifests with a reduced clinical response, and this theory is substantiated by the results of several investigations linking resistant strains to higher counts of P. acnes and therapeutic failure. 7,10,14,15 A systematic review of 50 clinical trials using topical antibiotics between 1974 and 2003 paints a startling picture: a significant decrease in the efficacy of topical erythromycin on inflammatory and non-inflammatory lesions over time (Figure 1). 16
Can antibiotics cause acne?
Although antibiotics play an important role in acne management, the increase in P. acnes resistance should be cause for concern and serve as the impetus for change in prescribing patterns and treatment algorithms. Not only are resistant strains linked to lack or worsening of clinical response to treatment, but the pathogenicity of P. acnes has increased over recent years, and most importantly prolonged regimens of antibiotic therapy have led to the transfer of resistance among non-targeted pathogenic bacteria. Limiting the frequency and duration of antibiotic use and adding the topical antimicrobial agent BPO will minimize the development of resistance while maintaining efficacy in the treatment of inflammatory and non-inflammatory acne lesions.
What is the role of antibiotic resistance?
The Action Plan is a blueprint for specific, coordinated federal actions to address the growing threat of antimicrobial resistance in the United States. The Action Plan addresses the four areas of federal action: surveillance, prevention and control, research, and product development.
Can antibiotics be used for acne?
Antibiotic monotherapy is not recommended to treat acne because of the risk of developing resistant bacteria. Application of topical antibiotics has been shown to promote resistant flora in skin of treated site 12,13 and oral antibiotics affects flora on all body sites. 14,15 Moreover, antibiotic monotherapy is not as effective as combination therapy with other agents, such as benzoyl peroxide. One meta-analysis found only an incremental benefit in adding clindamycin to benzoyl peroxide (BPO), with no benefit in within the first two to four weeks and marginal benefit after 10-12 weeks. 8 Moreover, one study looking at mild to moderate acne demonstrated similar efficacy between oral doxycycline 100 mg daily and BPO 5%. 9 In another study evaluating five different acne regimens, topical BPO and a combination BPO and erythromycin were found to have similar efficacy to oral antibiotics. 10
Is there a randomized controlled trial for antibiotic resistance?
Randomized, controlled trials evaluating antibiotic resistance and optimal antibiotic regimens are lacking . Most of the data we have regarding proper antibiotic use come from guidelines set forth by expert panels of key opinion leaders, case reports, and small studies. Several strategies have been suggested to minimize the risk of developing antibiotic resistance.
Antibiotic Resistance in Acne Therapy
- Propionibacterium acnes (P. acnes) is an anaerobic bacteria implicated in the pathogenesis of acne vulgaris. There are four primary pathogenic factors: excess sebum production, bacterial colonization, inflammation, and abnormal keratinization.1Treatment targets as many pathogenic factors as possible and may include a combination of topical and syst...
Evidence of Clinical Relevance
- Acne does not represent a typical bacterial infection, in which antibiotic resistance directly correlates to treatment failure, because antibiotics demonstrate both antibacterial and anti-inflammatory effects, and P. acnes – existing in the microaerophilic or anaerobic and lipid-rich environment of the pilosebaceous follicle – cannot easily be cultured. However, it is logical to as…
Strategies to Limit Resistance
- Since prescribing practice patterns directly influence the rates of P. acnes resistance in the population (i.e., the levels of resistance correlate to the levels of antibiotic use), and since selection pressure may affect more pathogenic bacteria than P. acnes, it makes sense to implement strategies and guidelines to limit antibiotic resistance.1 The Global Alliance to Impro…
Conclusion
- Although antibiotics play an important role in acne management, the increase in P. acnes resistance should be cause for concern and serve as the impetus for change in prescribing patterns and treatment algorithms. Not only are resistant strains linked to lack or worsening of clinical response to treatment, but the pathogenicity of P. acnes has increased over recent years…
References
- Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009 May;60(5 Suppl):S...
- Stern RS. Medication and medical service utilization for acne 1995-1998. J Am Acad Dermatol. 2000 Dec;43(6):1042-8.
- Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009 May;60(5 Suppl):S...
- Stern RS. Medication and medical service utilization for acne 1995-1998. J Am Acad Dermatol. 2000 Dec;43(6):1042-8.
- Webster GF. Acne vulgaris. BMJ. 2002 Aug 31;325(7362):475-9.
- Leyden JJ, Del Rosso JQ, Webster GF. Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: focus on antibiotic resistance. Cutis. 2007 Jun;79(6 Supp™l):9-25.
