Bacteriological resistance in acne: A call to action

Area of Science:

• Dermatology
• Microbiology
• Public Health

Background:

• Acne affects a significant portion of the adult population, with antibiotic therapies historically being a mainstay treatment.
• Increasing antibiotic resistance worldwide poses a major public health challenge, particularly in acne management due to large patient numbers and prolonged treatment durations.
• Overuse of antibiotics in acne treatment has led to rising resistance, necessitating a re-evaluation of current therapeutic strategies.

Purpose of the Study:

• To highlight the escalating issue of antibiotic resistance in acne treatment.
• To advocate for evidence-based guidelines and appropriate antibiotic use in managing acne.
• To encourage consideration of alternative acne treatments and revised antibiotic application protocols.

Main Methods:

• Review of existing literature on antibiotic resistance patterns in acne.
• Analysis of current treatment guidelines and their implications for antibiotic stewardship.
• Evaluation of recommended durations and combination therapies for topical and oral antibiotics.

Main Results:

• Antibiotic resistance to common topical agents like erythromycin and clindamycin has been documented since the 1970s and is increasing globally.
• Antibiotics are frequently overused in acne treatment, contributing significantly to the public health problem of resistance.
• Current evidence suggests topical antibiotics should not be used as monotherapy and combination use limited to four weeks.
• Oral antibiotics should also not be used as monotherapy, with combination therapy limited to four months.

Conclusions:

• Judicious and appropriate use of antibiotics is crucial to preserve their efficacy in acne management.
• Topical antibiotics should be limited to combination regimens for a maximum of four weeks.
• Oral antibiotics should be combined with topical retinoids or benzoyl peroxide for a maximum of four months.
• Greater physician awareness and adherence to guidelines are required to combat antibiotic resistance in acne treatment.