Antibiotic resistance is a serious concern, and it something we worry about when we are treating patients with acne. Bacteria are smart organisms. When they are exposed to a medication over and over again, they learn how to fight, or resist, the medication's killing effect. Overall, antibiotic resistance is increasing in acne patients, both because of their widespread use as well as because of the practice of rotating antibiotics. One study showed that the incidence of resistance to P. acnes increased from 20% in the 1978 to 62% in 1996. With P. acnes becoming more and more resistant to antibiotics, this becomes a major concern for acne management. Not only can medications be less effective, but antibiotics can also alter the normal bacterial flora that is present in the body, possibly increasing the susceptibility to other infections. A few studies in college students showed that students who were on antibiotics with acne were a lot more likely to develop pharyngitis (throat infections) than students who were not on antibiotics.
So what can we do to help decrease antibiotic resistance? There are a few practices we try to follow when treating patients:
- We reserve antibiotics for when they are truly necessary. We definitely might consider giving you a trial of an oral antibiotic for acne, but only if it is an appropriate option.
- If we do prescribe an oral antibiotic for acne, we will recommend to you that it be stopped in about 3-4 months. If your acne flares immediately after stopping the antibiotic, it will be time to discuss hormonal therapy or isotretinoin therapy.
- We like to give it about 6-8 weeks before deciding that an antibiotic is not working. If we stop it too quickly and change to another antibiotic, we run the risk of teaching the bacteria to outsmart the medication. After 6-8 weeks, if the antibiotic is not working, we may consider changing you to a different antibiotic.
- If you stop your antibiotics and need to restart it for whatever reason, we will usually try to keep you on the same type of antibiotic as long as it is still effective.
- The use of benzoyl peroxide can help prevent the emergence of antibiotic resistance. When appropriate, we prescribe benzoyl peroxide containing products to patients while they are on antibiotics.
- Topical retinoids can help decrease how long you need to be on an antibiotic, so when appropriate, we will often prescribe these with the plan for you to continue the topical retinoid after the antibiotic is stopped.
- There are a couple of very low-dose antibiotic options that, in theory, do not lead to the development of resistance. We will sometimes consider these as maintenance therapy.
The most important thing is to follow up regularly with us so that we can determine when we need to change plans. Together, we can usually find something that not only gives you great skin but that also keeps you healthy.