Antibiotics and acne

Information on antibiotic resistance

Antibiotics have been a mainstay of acne treatment for decades. Antibiotics help kill acne bacteria (P. acnes) and also help reduce inflammation.1-4 However, it has also long been noted that they only work for about half of the population, and produce only moderate effectiveness.5 Next, they often only work for a short period of time. Acne tends to "get used to" both oral and topical antibiotic treatments and become resistant to it.1,6 As more research comes to light, it appears antibiotics are not helping clear acne as well as they once did. Researchers theorize this may be directly related to increased bacterial resistance across the population.6

Stats

A large study conducted by the British Journal of Dermatology in 2002 studied 4274 acne patients and found that since 1991 an average of 51% of patients harbored colonies of resistant bacteria.9 Other studies have shown similar levels of antibiotic resistant acne bacteria.10 Interestingly, researchers are finding similar levels of resistance in both patients treated with antibiotics and those untreated as well, although those untreated have somewhat lower levels of resistance.11

How it happens

On a microscopic level, geneticists and biologists are finding multiple possible reasons why this occurs. The first is gene mutation within a bacteria cell.2,12-14 Bacteria have also been observed banding together and producing biofilms, a coating which slows penetration of antibacterial medication.4

What to do about it

First, have a talk with your doctor if you are on long-term antibiotic therapy. Next, if you are prescribed antibiotics from a doctor, do not stop your course before speaking with her/him about it.

What stands out in the literature most boldly is the value of combining antibiotics with benzoyl peroxide or retinoids.2-3,15-19 When mixed with benzoyl peroxide, antibiotic therapy kills 99.9% of bacteria, resistant or not.15 Data is less available regarding the combination of retinoids such as Retin-A® or Adapalene® with antibiotic treatment. Lastly, isotretinoin (Accutane) has been shown to kill about 90% of these resistant bacteria, but still leave large colonies behind.15

I was on oral and/or topical antibiotics for a year or so altogether during high school and college. Neither therapy did anything for me. My skin was at its worst in my lifetime when I was on Clindamycin, a topical antibiotic. Antibiotics for me were like a bad joke—promising help but delivering nothing. Accutane finally cleared me up, although not entirely. When my acne returned after my Accutane course, The Regimen here at Acne.org finally got me cleared up for good."

Dan Kern
Acne.org Founder
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References

References

  1. Leyden J, Levy S. "The development of antibiotic resistance in Propionibacterium acnes." Cutis. 2001 Feb;67(2 Suppl):21-4.
  2. Leyden, JJ. "Current issues in antimicrobial therapy for the treatment of acne." Journal of the European Academy of Dermatology and Venereology. 2001;15 Suppl 3:51-5.
  3. Ochsendorf F. "Systematic therapy of acne vulgaris." Journal of the German Society of Dermatology. 2006 Oct;4(10):828-41.
  4. Thevarajah S, Balkrishnan R, Camacho FT, Feldman SR, Fleischer AB Jr. "Trends in prescription of acne medication in the US: shift from antibiotic to non-antibiotic treatment." The Journal of Dermatologic Treatment. 2005;16(4)224-8.
  5. Ozolins M, Eady EA, Avery A, Cunliffe WJ, O'Neill C, Simpson NB, Williams HC. "Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne." Health Technology Assessment. 2005 Jan;9(1):iii-212.
  6. Eady AE, Cove JH, Layton AM. "Is antibiotic resistance in cutaneous propionibacteria clinically relevant? : implications of resistance for acne patients and prescribers." American Journal of Clinical Dermatology. 2003;4(12):813-31.
  7. Simonart T, Dramaix M. "Treatment of acne with topical antibiotics: lessons from clinical studies." The British Journal of Dermatology. 2005 Aug;153(2):395-403.
  8. Eady, EA, Gloor M, Leyden JJ. "Propionibacterium acnes resistance: A world wide problem." Dermatology. 2003;206:11-16.
  9. Coates P, Vyakrnam S, Eady EA, Jones CE, Cove JH, Cunliffe WJ. "Prevalence of antibiotic-resistant propionibacteria on the skin of acne patients: 10-year surveillance data and snapshot distribution study." The British Journal of Dermatology. 2002 May;146(5):840-8.
  10. Ross JI, Snelling AM, Carnegie E, Coates P, Cunliffe WJ, Bettoli V, Tosti G, Katsambas A, Galvan Perez Del Pulgar JI, Rollman O, Torok L, Eady EA, Cove JH. "Antibiotic-resistant acne: lessons from Europe." The British Journal of Dermatology. 2003 Mar;148(3)467-78.
  11. Dreno B, Reynaud A, Moyse D, Habert H, Richet H. "Erythromycin-resistance of cutaneous bacterial flora in acne." European Journal of Dermatology. 2001 Nov-Dec;11(6):549-53.
  12. Del Rosso JQ, Leyden JJ, Thiboutot D, Webster GF. "Antibiotic use in acne vulgaris and rosacea: clinical considerations and resistance issues of significance to dermatologists." Cutis. 2008 Aug;82(2 Suppl 2):5-12.
  13. Ishida N, Nakaminami H, Noguchi N, Kurokawa I, Nishijima S, Sasatsu M. "Antimicrobial susceptibilities of Propionibacterium acnes isolated from patients with acne vulgaris." Microbiology and Immunology. 2008 Dec;52(12):621-4.
  14. Ross JI, Snelling AM, Eady EA, Cove JH, Cunliffe WJ, Leyden JJ, Collignon P, Dr Kno B, Reynaud A, Fluhr J, Oshima S. "Phenotypic and genotypic characterization of antibiotic-resistant Propionibacterium acnes isolated from acne patients attending dermatology clinics in Europe, the U.S.A., Japan and Australia." The British Journal of Dermatology. 2001 Feb;144(2):339-46.
  15. Coates P, Vyakrnam S, Ravenscroft JC, Stables GI, Cunliffe WJ, Leyden JJ, Johnson J, Eady EA, Cove JH. "Efficacy of oral isotretinoin in the control of skin and nasal colonization by antibiotic-resistant propionibacteria in patients with acne." The British Journal of Dermatology. 2005 Dec;153(6):1126-36.
  16. Leyden JJ. "Antibiotic resistance in the topical treatment of acne vulgaris." Cutis. 2004 Jun;73(6 Suppl):6-10.
  17. Leyden JJ, Wortzman M, Baldwin EK. "Antibiotic-resistant Propionibacterium acnes suppressed by a benzoyl peroxide cleanser 6%." Cutis. 2008 Dec;82(6):417-21.
  18. Leyden JJ. "Effect of topical benzoyl peroxide/clindamycin versus topical clindamycin and vehicle in the reduction of Propionibacterium acnes." Cutis. 2002 Jun;69(6):475-80.
  19. Worret WI, Fluhr JW. "Acne therapy with topical benzoyl peroxide, antibiotics and azelaic acid." [Article in German] Journal of the German Society of Dermatology. 2006 Apr;4(4):293-300.

Further Reading

  1. Bojar RA, Holland KT. "Acne and Propionibacterium acnes." Clinics in Dermatology. 2004 Sep-Oct;22(5):375-9.
  2. Del Rosso JQ. "Selection of therapy for acne vulgaris: balancing concerns about antibiotic resistance." Cutis. 2008 Nov;82(5 Suppl):12-6.
  3. Dr Kno B. "General antibiotic therapy in acne." [Article in French] La Revue du praticien. 2002 Apr 15;52(8):841-3.
  4. Garner SE, Eady EA, Popescu C, Newton J, Li WA. "Minocycline for acne vulgaris: efficacy and safety." Cochrane Database of Systematic Reviews. 2003;(1):CD002086.
  5. Leyden JJ, Del Rosso JQ, Webster GF. "Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: a status report." Dermatologic Clinics. 2009 Jan;27(1):1-15.
  6. Leyden JJ. "Effect of topical benzoyl peroxide/clindamycin versus topical clindamycin and vehicle in the reduction of Propionibacterium acnes." Cutis. 2002 Jun;69(6):475-80.
  7. McInturff JE, Wang SJ, Machleidt T, Lin TR, Oren A, Hertz CJ, Krutzik SR, Hart S, Zeh K, Anderson DH, Gallo RL, Modlin RL, Kim J. "Granulysin-derived peptides demonstrate antimicrobial and anti-inflammatory effects against Propionibacterium acnes." Journal of Investigative Dermatology. 2005 Aug;125(2):256-63.
  8. Mills O Jr, Thornsberry C, Cardin CW, Smiles KA, Leyden JJ. "Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle." Acta Dermato-venereologica. 2002;82(4):260-5.
  9. Ochsendorf F. "Systematic therapy of acne vulgaris." Journal of the German Society of Dermatology. 2006 Oct;4(10):828-41.
  10. Oprica C, Emtestam L, Lapins J, Borglund E, Nyberg F, Stenlund K, Lundeberg L, Sillerstem E, Nord CE. "Antibiotic-resistant Propionibacterium acnes on the skin of patients with moderate to severe acne in Stockholm." Anaerobe. 2004 Jun;10(3):155-64.
  11. Qureshi A. "Survival of antibiotic-resistant Propionibacterium acnes in the environment." 14th European Congress of Clinical Microbiology and Infectious Diseases 2004, Prague, poster presentation. Abstract number: 902_p818. Accessed online on the 8th of April, 2009. link.
  12. Zouboulis CC, Piquero-Martin J. "Update and future of systemic acne treatment." Dermatology. 2003;206(1):37-53.