Antibiotic Resistance Risk with Oral Tetracycline Treatment of Acne Vulgaris

Abstract

Almost 1 billion people worldwide have acne, and oral tetracyclines, including doxycycline and minocycline, are effective and frequently prescribed treatments for acne. However, there is growing concern for the development of antibiotic resistance with such widespread utilization by dermatologists. Additionally, tetracyclines are known to have various potential side effects, including gut dysbiosis, gastrointestinal upset, photosensitivity, dizziness, and vertigo. However, in 2018 a novel narrow-spectrum tetracycline, sarecycline, was Food and Drug Administration-approved to treat moderate-to-severe acne vulgaris in patients 9-years-old and above. Sarecycline was designed to target Cutibacterium acnes, the pathogenic bacterium in acne vulgaris, which may reduce the risk of resistance. This paper examines the growing concerns of antibiotic resistance due to oral tetracycline usage in the treatment of acne vulgaris, with a focus on the promising third-generation, narrow-spectrum tetracycline, sarecycline.

Polymeric Nanoparticles as Tunable Nanocarriers for Targeted Delivery of Drugs to Skin Tissues for Treatment of Topical Skin Diseases

“…Oral antibiotics in combination with topical retinoids and BP can be used to reduce risks of possible bacterial resistance [ 143 ]. Tetracyclines including minocycline, doxycycline, and tetracycline are considered the first line treatment, except when they are contradicted such as during pregnancy, in children <9 years, or in the case of an allergy; in such cases, erythromycin can be used as an alternative [ 144 ]. In addition, hormonal therapy can be used to reduce the severity of acne.…”

Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances

“…There is no sufficient data in the literature to prove that minocycline and doxycycline are more efficient than tetracycline's. Furthermore, tetracyclines have been associated with reduced resistance in P. acnes than macrolides [ 74 ].…”

Bidirectional Interaction between Tetracyclines and Gut Microbiome

“…The gut microbiome is composed of many different species of bacteria that interact with each other in complex ways. When antibiotics are administered, they can disrupt these interactions, leading to changes in the microbial community structure [ 78 , 79 , 80 ]. This can result in a decrease in diversity as certain species become dominant and others are eliminated or suppressed.…”