Systematic review of Propionibacterium acnes resistance to systemic antibiotics.
OBJECTIVE
To document changes in the prevalence of resistance of Propionibacterium acnes to antibiotics used for treating acne.


METHODS
MEDLINE and EMBASE were searched for publications on P. acnes resistance to systemic antibiotics. The search strategy mapped "acne" or "acne vulgaris" with the terms "antibiotic resistance" or "drug resistance, microbial". Only papers published in English during 1976 to 1997 were included in the search.


METHODS
53 publications met the search criteria. The search output was refined by selecting papers that specifically addressed P. acnes resistance patterns. Additional studies (not included in the search output) were identified from review articles and references of the retrieved articles. Twelve articles were reviewed.


METHODS
Data on the prevalence of antibiotic-resistant propionibacteria, the incidence of individual resistance phenotypes, mixed resistance, and correlation between poor therapeutic response and resistant propionibacteria were extracted.


RESULTS
Research since 1978 has suggested an association between poor therapeutic response and antibiotic-resistant propionibacteria. The overall incidence of P. acnes antibiotic resistance has increased from 20% in 1978 to 62% in 1996. Resistance to specific antibiotics varied and was most commonly reported with erythromycin and clindamycin, tetracycline and doxcycline, and trimethoprim. Resistance to minocycline is rare.


CONCLUSIONS
In many patients with acne, continued treatment with antibiotics can be inappropriate or ineffective. It is important to recognise therapeutic failure and alter treatment accordingly. The use of long-term rotational antibiotics is outdated and will only exacerbate antibiotic resistance.
Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW.
A J
AJ
Cooper
D000152:Acne Vulgaris / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D011425:Propionibacterium acnes / Q000187:drug effects*