The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: a review.
OBJECTIVE
To review recent studies on the use of antibiotics in acne vulgaris which provide insight into the development of antimicrobial resistance.


METHODS
Sources for this article were identified by searching the English literature by Medline for the period 1960 to March 2009.


METHODS
The following relevant terms were used: acne, acne vulgaris, acne and antibiotic therapy, acne and antimicrobial resistance, acne and resistance mechanisms, acne and systemic infections, acne and antibiotic resistance and coagulase-negative Staphylococcus aureus (S. aureus), acne and antibiotic resistance and upper respiratory infection.


RESULTS
Both correct and incorrect use of antibiotics for acne vulgaris can promote antimicrobial resistance. The development of this resistance is promoted by several factors, including antibiotic monotherapy, long-term administration of antibiotics, indiscriminate use outside their strict indications, dosing below the recommended levels, and the administration of antibiotics without concurrent benzoyl peroxide and/or topical retinoids.


CONCLUSIONS
Long-term use of antibiotics in the treatment of acne vulgaris can lead to antimicrobial resistance with serious and intractable problems not limited to Propionibacterium acnes (P. acnes), the skin and acne vulgaris themselves, but also to other bacterial species, with systemic consequences. These findings suggest that antibiotics should be prescribed in combination with benzoyl peroxide and/or topical retinoids and be limited to a maximum of several months.
Patel
Mital
M
Department of Dermatology, State University of NewYork, Downstate Medical Center, Brooklyn, NY, USA.
Bowe
Whitney P
WP
Heughebaert
Carol
C
Shalita
Alan R
AR
D000152:Acne Vulgaris / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D006801:Humans; D011425:Propionibacterium acnes / Q000187:drug effects; D013210:Staphylococcus / Q000187:drug effects; D013297:Streptococcus pyogenes / Q000187:drug effects
D000900:Anti-Bacterial Agents