The most striking finding from a recent review of the impact of acne-related antibiotic use on microbial resistance is a lack of high-quality studies upon which to base recommendations. However, authors conclude, the few studies available sound sufficient alarm to renew major dermatologic societies’ calls to limit antibiotic use wherever possible.
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, MD, a second-year dermatology resident (PGY-3) at the University of Southern California Keck School of Medicine.
“Studies can be meaningful in 2 directions: positive findings, or an absence of findings. The latter is more relevant to what we found.” Dating back to 1987, researchers examined five clinical trials (none randomized) that reported patient-level data.
“Essentially, we don’t know as much as we should about problems relating to antibiotic resistance in acne because of a lack of good, high-quality studies. The little that we do know is troubling enough” that possible changes to prescribing habits must continue to be discussed.
AAD AND EADV RECOMMENDATIONS
Both the American Academy of Dermatology (AAD) and the European Academy of Dermatology and Venereology (EADV) discourage topical or oral antibiotic monotherapy. “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, said Adler.
“Often,” he said, “our solution for avoiding monotherapy is having patients use over-the-counter products like benzoyl peroxide (BP) – which they’re not always purchasing. This can lead to a kind of functional monotherapy. So even though we may be recommending the use of benzoyl peroxide, that’s not always being adhered to on the patient end. That’s why patient education becomes such a major focus.”
As dermatology residents, “We’ve been very well exposed to the idea of combination therapy for acne. There are excellent combination products available that incorporate a topical antibiotic with benzoyl…