Antibiotic stewardship in dermatology: limiting antibiotic use in acne.
OBJECTIVE
Widespread use of antibiotics in all areas of medicine has led to significant problems with antimicrobial resistance, which have begun to compromise the usefulness of antibiotics. Antibiotics have long been a keystone of acne therapy. There is a large population of patients with acne and antibiotic therapy is often used for long durations; thus, acne therapy results in extensive antibiotic exposure. This article discusses the role of antibiotic therapy in acne from the perspective of how clinicians can best preserve the utility of these important drugs while providing efficacious and safe therapy for acne patients.


METHODS
Review of literature augmented by expert opinion when literature was sparse.


RESULTS
Antibiotic monotherapy (topical or oral) is not recommended due to the availability of clinically superior regimens. Systemic antibiotics are important for managing moderate to severe acne and should be used for a limited duration of time (3-4 months). Topical antibiotics should be paired with benzoyl peroxide to limit potential for resistance. Information gained in recent years about the pathophysiology of acne has shed light on the role of Propionibacterium acnes as well as other key pathogenic pathways such as inflammation.


CONCLUSIONS
The improved understanding of acne pathogenic mechanisms can and should be applied to develop modern therapeutic approaches that are efficacious and mesh with current public health concerns.
Department of Dermato-Cancerology, University of Nantes, Nantes, France.
Brigitte
B
Dreno
Department of Dermatology, Penn State University College of Medicine, Hershey, Pennsylvania, USA.
Diane
D
Thiboutot
Department of Dermatology and Venereology Medical Faculty, Otto-Von-Guericke-Universitat, Magdeburg, Germany.
Harald
H
Gollnick
Section of Dermatology, Azienda Ospedaliera, University of Ferrara, Italy.
Vincenzo
V
Bettoli
Department of Dermatology, Johns Hopkins Medicine, Baltimore, USA.
Sewon
S
Kang
Department of Dermatology, University of Pennsylvania School of Medicine, Pennsylvania, USA.
James J
JJ
Leyden
Department of Dermatology, State University of New York, Brooklyn, New York, USA.
Alan
A
Shalita
Department of Dermatology, Juarez Hospital, Mexico City, Mexico.
Vicente
V
Torres
D000152:Acne Vulgaris / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans
D000900:Anti-Bacterial Agents
acne; antibiotics; antimicrobial resistance; public health