Antibiotic Treatment for Acne Is Worsening the Worldwide Problem of Antibiotic Resistance
The Essential Info
Acne is in part a bacterial disease, and antibiotics can help to keep bacteria in check in the short term and to a limited degree in some people. They may also help reduce the inflammatory component of acne, but again, only in the short term and to a limited degree.
However, particularly when taken for extended periods of time, antibiotics can lead to lifelong antibiotic resistance for the user and the world at large.
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, and when they are used, they should be used sparingly and only for short periods of time (maximum 3 months).
Be Your Own Advocate: If your doctor prescribes an oral or topical antibiotic to treat your acne, do not simply accept it without question. Ask your doctor about other treatments you can use instead of antibiotics. If you do use antibiotics, remember that many experts caution against using them for more than 3 months. Also, always take them on time and complete the entire prescribed course, because skipping doses or stopping too soon increases the chances of developing resistant bacteria.
- What Is Antibiotic Resistance, and Why Is It a Problem?
- Both Topical and Oral Antibiotic Treatment for Acne May Worsen the Problem
- Antibiotics Used to Treat Acne Cause Antibiotic Resistance
Doctors sometimes prescribe antibiotics to treat acne, especially severe acne. This is highly controversial because they do not tend to work better than other medications, and sometimes do not work at all. They also only offer short-term relief and have significant drawbacks that limit their usefulness.
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.
Another important drawback that is often missed because it does not show up in the short term as an obvious side effect is a phenomenon called antibiotic resistance, which affects not only the individual taking the antibiotic but the world as a whole. In this article, we will discuss the problem of antibiotic resistance.
What Is Antibiotic Resistance, and Why Is It a Problem?
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:
- 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.
- Antibiotic resistance can result in a snowball effect. Bacteria can share their genes with each other and transfer antibiotic resistance from one strain of bacteria to another.
- Antibiotic resistant bacteria can easily be transferred from one person to another simply through touch.
- Ultimately, antibiotic resistance could result in many types of bacteria becoming resistant to all antibiotic medications. This means that doctors may eventually be unable to treat bacterial infections and that people may die from even common bacterial diseases such as strep throat, just like people did before antibiotics were developed.
Both Topical and Oral Antibiotic Treatment for Acne May Worsen the Problem
“Despite the efficacy of antibiotics, there have been calls to limit their use in acne because of concerns for bacterial resistance.”1
In fact, several researchers have pointed out that antibiotic prescriptions for acne are a major source of concern, as acne is the most common condition for which dermatologists prescribe antibiotics. Research suggests that acne patients who are treated with antibiotics not only develop antibiotic-resistant bacteria, but are also very likely to transfer these bacteria to other people.2
Expand to read details of research
Because of increasing concern about antibiotic resistance, scientists recommend that antibiotics not be used to treat acne when possible, and when needed, antibiotics should be used only for short periods of time (up to 3 months).1,3
Expand to read scientists’ recommendations
Why Using Antibiotics for Longer Periods of Time Causes Problems
The reason that scientists recommend limiting antibiotic usage to 3 months is that longer treatment periods expose bacteria to the antibiotic for extended periods of time, giving the bacteria time to develop resistance. However, in a worrisome finding, doctors often prescribe antibiotics for considerably longer than 3 months, as two recent studies reported.1,4
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Antibiotics Used to Treat Acne Cause Antibiotic Resistance
Recent research indicates that some of the antibiotics that are most frequently prescribed for acne, such as erythromycin and clindamycin, are already creating a high incidence of antibiotic resistance. Studies performed in Europe and Hong Kong have found antibiotic-resistant bacteria in approximately half or more of acne patients.5-7
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Interestingly, researchers have noted similar levels of resistance both in patients treated with and without antibiotics, although those who were not treated with antibiotics have somewhat lower levels of resistance.8 This is because resistant strains of bacteria are easily transmitted between people.9
Of all topical antibiotics, resistance to erythromycin is most common, as two scientific articles point out.3,9
Expand to read quotes from articles
Resistance to erythromycin and clindamycin is now a worldwide problem, which is made worse by the fact that resistant bacteria can be transferred from person to person.
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
In order to reduce the risk of antibiotic resistance, scientists recommend replacing oral antibiotics with a topical treatment regimen, such as benzoyl peroxide and topical retinoids (tretinoin, adapalene, or tazarotene), whenever possible.
If doctors do prescribe antibiotics for acne, they should combine antibiotics with benzoyl peroxide or topical retinoids, in addition to keeping treatment duration to 3 months or less. These recommendations were described in two recent article for doctors.9,10
Expand to read quotes from articles
Researchers also recommend raising awareness of antibiotic resistance among people with acne. A recent survey found that many younger acne patients underestimate the risks of antibiotic overuse.11
Expand to read details of survey
As we have seen in this article, treatment with antibiotics, especially for prolonged periods of time, leads to antibiotic resistance, and this resistance is becoming a significant worldwide problem that threatens to undermine our ability to treat bacterial infections in the future. This could lead to people dying from even simple bacterial infections that we now routinely treat with antibiotics.
Given the dangers of antibiotics, they should only be used as drugs of last resort for acne treatment. If deemed necessary, they should be administered sparingly and for short duration (less than 3 months).
- Nagler, A. R., Milam, E. C. & Orlow, S. J. The use of oral antibiotics before isotretinoin therapy in patients with acne. J. Am. Acad. Dermatol. 74, 273 – 279 (2016). https://www.ncbi.nlm.nih.gov/pubmed/26525749
- Sardana, K., Gupta, T., Garg, V. K. & Ghunawat, S. Antibiotic resistance to Propionobacterium acnes: worldwide scenario, diagnosis and management. Expert Rev. Anti. Infect. Ther. 13, 883 – 896 (2015). https://www.ncbi.nlm.nih.gov/pubmed/26025191
- Strauss, J. S. et al. Guidelines of care for acne vulgaris management. J. Am. Acad. Dermatol. 56, 651 – 663 (2007). https://www.ncbi.nlm.nih.gov/pubmed/17276540
- Lee, Y. H., Liu, G., Thiboutot, D. M., Leslie, D. L. & Kirby, J. S. A retrospective analysis of the duration of oral antibiotic therapy for the treatment of acne among adolescents: investigating practice gaps and potential cost-savings. J. Am. Acad. Dermatol. 71, 70 – 76 (2014). https://www.ncbi.nlm.nih.gov/pubmed/24725476
- Coates, P. et al. Prevalence of antibiotic-resistant propionibacteria on the skin of acne patients: 10-year surveillance data and snapshot distribution study. Br. J. Dermatol. 146, 840 – 848 (2002). http://europepmc.org/abstract/med/12000382
- Ochsendorf, F. [Systemic antibiotic therapy of acne vulgaris]. J. Dtsch. Dermatol. Ges. 8 Suppl 1, S31 – 46 (2010). https://www.ncbi.nlm.nih.gov/pubmed/17010172
- Luk, N. M. et al. Antibiotic-resistant Propionibacterium acnes among acne patients in a regional skin centre in Hong Kong. J. Eur. Acad. Dermatol. Venereol. 27, 31 – 36 (2013). https://www.ncbi.nlm.nih.gov/pubmed/22103749
- Del Rosso, J. Q., Leyden, J. J., Thiboutot, D. & Webster, G. F. Antibiotic use in acne vulgaris and rosacea: clinical considerations and resistance issues of significance to dermatologists. Cutis 82, 5 – 12 (2008). https://www.ncbi.nlm.nih.gov/pubmed/18924545
- Oudenhoven, M. D., Kinney, M. A., McShane, D. B., Burkhart, C. N. & Morrell, D. S. Adverse effects of acne medications: recognition and management. Am. J. Clin. Dermatol. 16, 231 – 242 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25896771
- Rueda MJ. Patient Awareness of Antimicrobial Resistance and Antibiotic Use in Acne Vulgaris. J. Clin. Aesthet. Dermatol. 12, 30-41 (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624010/
- Walsh T. R., Efthimiou J., Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. Lancet Infect Dis. 16, e23-33 (2016). https://www.ncbi.nlm.nih.gov/pubmed/26852728