Stemming the tide of antimicrobial resistance: implications for management of acne vulgaris

Acne can cause substantial distress, decreased self-confidence and increased rates of depression and suicidal ideation.¹ Topical and oral antibiotics are commonly used to treat acne, due to both antimicrobial and anti-inflammatory mechanisms of action, but they are not always effective and alternatives are available.² Whereas topical antibiotics predispose to overgrowth of antibiotic resistant bacteria on treated skin sites, oral antibiotics increase the numbers of resistant bacteria not only on the skin but at all body sites with resident commensal microflora. Examples include overgrowth of resistant strains of Propionibacterium acnes ³ and coagulase-negative staphylococci on the skin⁴ as well as coliforms in the gut. Resistance emerges not only in treated patients but also in close contacts.^3,4

A strong case has been made for reducing antibiotic prescribing in primary care but relatively little emphasis has been placed on antibiotic prescribing for acne.⁵ However, skin conditions account for 8% of primary care antibiotic prescribing and there is rising concern about ‘collateral damage to the steady-state microbiome’ of long-term antibiotic use in young people.³

A recent analysis of the Clinical Practice Research Datalink (CPRD) examined primary care consultations and prescriptions administered for acne.⁶ This suggested that GPs prescribe oral antibiotics at 31% of first consultations for acne,⁶ though it is not clear whether this is due to GP prescribing habits or pressure from patients. Over 90% of …