Antibiotics for acne: combating resistance

The good news about having acne is that there’s a range of effective treatment options, including antibiotics. However, as antibiotic resistance is a growing problem, it’s really important to use antibiotics responsibly so these critical medicines stay effective against many medical conditions.

How antibiotics work to treat acne

While antibiotics can kill the bacteria that causes acne, it’s actually their anti-inflammatory effects that provide the biggest acne benefits. This means antibiotics are used to treat inflammatory acne – small, pink lumps and bumps, and pustules on the skin’s surface. In more serious cases, the lumps are larger, deeper and may appear as nodules and cysts.

With more than half of acne-causing bacteria now resistant to some commonly used antibiotics such as erythromycin, medical experts are working on new approaches when it comes to treating acne with antibiotics.

Combine antibiotics with other treatments

As part of the Choosing Wisely Australia campaign from NPS Medicinewise, The Australasian College of Dermatologists advises people with acne avoid relying solely on oral or topical antibiotics, a recommendation supported by All About Acne.

Combining the use of antibiotics with benzoyl peroxide or retinoids will reduce the development of resistance.

Melbourne dermatologist and All About Acne member, Dr Mei Tam said antibiotics should not be used as the only strategy for acne, especially both topical and oral antibiotics at the same time as this only encourages resistance.

“People with mild to moderate acne should have a trial of three to six months maximum in combination with benzoyl peroxide and retinoids. If that’s not controlling acne, move on to other treatments.”

“Most people should have their strategy reviewed if they are requiring antibiotics for longer than six months.”

“When acne has improved, especially if pores have been unblocked, then the antibiotics should be able to be phased out and stopped whilst continuing on their topical benzoyl peroxide or retinoid.”

Dr Tam added that patients with severe acne should consider taking antibiotics for the first four to six weeks of isotretinoin treatment to prevent flare-ups, then continue with isotretinoin alone.

Consumer understanding of antibiotic resistance

A US survey of 809 people with acne (17-40 years) and 210 parents of children with acne (9-17 years) sponsored by Galderma found:

• 64% of survey respondents were not aware that overuse of topical antibiotics to treat acne could make them a carrier of drug-resistant bacteria
• More than 50% of respondents had not spoken with their doctor about the risk of antibiotics to treat acne
• 65% of respondents said that they try to avoid antibiotics unless they are the only option
• Only one-third of those prescribed antibiotics were aware other treatment options existed

Find out more about medical treatments for acne

Dermatologist - MBBS, FACD Dr Tam works as a consultant dermatologist at St. Vincent’s Hospital and the Skin Health Institute (previously known as the Skin and Cancer Foundation Inc). She also runs a private general dermatology practice in Melbourne. Dr Tam has collaborated in a prospective clinical trial looking at acne, isotretinoin with quality of life and depression, which was published in the Australasian Journal of Dermatology (Nov 2002). She runs a patch test contact dermatitis clinic at Skin Health Institute and has a keen interest in this field and clinical dermatology. Dr Tam has been a Fellow of the Australasian College of Dermatologists since 1998.

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