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Antibiotics for Acne Disturb the Oropharyngeal Flora

Antibiotic treatment for acne encourages microbial resistance.

Clinicians commonly prescribe long-term topical and systemic antibiotics to treat acne. A potential complication is the emergence of antibiotic-resistant organisms. Investigators in this study examined the oropharyngeal flora of 105 people (70% women; average age, 24.5) who had or had not received antibiotics to treat acne.

The researchers compared oropharyngeal Staphylococcus aureus and Streptococcus pyogenes (Group A streptococci) in 42 patients who had taken antibiotics (topically, orally, or both) for at least 3 months and in 63 patients who had taken no antibiotics for at least 6 months. Patients who received antibiotics had taken oral tetracycline, minocycline, and doxycycline, and the susceptibility of the cultured organisms was tested against these agents. The topical agents were not identified.

S. pyogenes was cultured from 33% of the antibiotic group but only 10% of the comparison group, a significant difference. S. aureus was present in 22% of the antibiotic group and 29% of the comparison group. More antibiotic recipients had resistant S. pyogenes (85% vs. 20%) and resistant S. aureus (44% vs. 18%). Both differences in antimicrobial susceptibility were significant.

Comment: These results demonstrate that long-term use of oral or topical antibiotics causes colonization with resistant organisms. The isolation rates of S. aureus and S. pyogenes in the oropharynges of these patients were higher than previously recorded in healthy populations, suggesting that acne itself may promote colonization. Although the authors found no increased rate of respiratory infections in the antibiotic recipients, the presence of resistant organisms is worrisome, especially as these organisms may be transmitted to close contacts. Clinicians should probably avoid antibiotic treatment (except, perhaps, low-dose doxycycline) for acne, unless other therapies fail.

— Jan V. Hirschmann, MD

Published in Journal Watch Dermatology May 14, 2003

Citation(s):

Levy RM et al. Effect of antibiotics on the oropharyngeal flora in patients with acne. Arch Dermatol 2003 Apr; 139:467-71.

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