Sequential antibiotic therapy for acne promotes the carriage of resistant staphylococci on the skin of contacts

Abstract

The selection of a predominantly resistant staphylococcal skin flora in acne patients during antibiotic treatment has been extensively documented. This study sought to determine whether antibiotic therapy for acne had any effect on skin carriage of resistant coagulase-negative staphylococci (CNS) by close contacts of treated patients. Bacterial samples were obtained using a scrub wash technique from facial skin of 41 contacts (parents, siblings or partners) of patients who had been treated with at least three different antibiotics over a minimum period of 2 years. Samples were also obtained from 41 control subjects who had no known contact with any antibiotic treated acne patient. None of the contacts or controls had received any antibiotic therapy in the preceding two years. The number, percentage and prevalence of CNS resistant to each of seven antibiotics was estimated by plating serial ten-fold dilutions of wash fluid directly onto antibiotic-containing and antibiotic-free medium. Significantly more contacts than controls carried strains resistant to erythromycin, clindamycin, fusidic acid, trimethoprim and chloramphenicol as well as more multiply resistant strains (P < 0.05, chi 2). The number and percentage of staphylococci resistant to tetracycline, erythromycin, clindamycin, fusidic acid and chloramphenicol were also significantly raised (P < 0.05, Mann-Whitney U-test) in contacts. Only aminoglycoside resistance was not increased by any of the above criteria. These observations provide evidence that sequential antibiotic therapy for acne exerts selective pressure for increased skin carriage of resistant CNS not only in patients but also in their close contacts.

Effect of Antibiotics on the Oropharyngeal Flora in Patients With Acne

“…2,3 Tetracyclines and erythromycin are 2 antibiotics commonly used in dermatological practice for the long-term treatment of acne vulgaris. 1 Studies have shown that Propionibacterium acnes and coagulase-negative staphylococci quickly develop resistance to these antibiotics, 4,5 which may result in therapeutic failure and the propagation of resistance to bacteria in the skin 6 and gastrointestinal flora of close contacts. 7 While the effects of longterm antibiotic use on cutaneous microbial environments in this patient population have been well studied, the effects on noncutaneous surfaces such as the oropharynx (which could be a source of systemic illness) have not.…”

“…While tetracycline-resistant cutaneous flora has been a well-documented consequence of antibiotic therapy for acne, [4][5][6] increased colonization of tetracycline-resistant bacteria in the oropharynx has never been consistently associated with pathogenic disease. Our study is limited in that we only investigated bacterial resistance to tetracycline antibiotics.…”

Assessment of nasal carriage of staphylococcus aureus in patients with acne vulgaris

“…Sistemik antibiyotiklerin kullanımına bağlı dirençli suşların gelişmesi klinik bir problemdir. Uzun süreli antibiyotik kullanan akneli hastalarda dirençli stafilokok suşlarına bağlı deri enfeksiyonlarının ortaya çıktığı bildirilmiştir 14 . Ancak gerek sistemik gerekse topikal antibiyotik tedavisi alan akneli hastalarda S. aureus kolonizasyon oranının %70 oranında azaldığını bildiren yayınlar mevcuttur.…”

Management of acne

“…Systemic antibiotics should not be used to treat mild acne because of the risk of increasing resistance. 23,24 The additional use of nonantibiotic topical agents in combination with oral antibiotics should be considered. 4 Topical retinoids with oral antibiotics may give a faster response and be more effective than either drug used alone.…”