A Controversial Proposal

No More Antibiotics for Acne!

Muneeza Muhammad, BA; Ted Rosen, MD


Skin Therapy Letter. 2013;18(5) 

In This Article

Abstract and Introduction


Administration of antibiotics, often for prolonged periods, has become the de facto standard of care for acne (and rosacea). However, the world is now facing a health crisis relating to widespread antibiotic resistance. The authors provide current evidence to suggest that dermatologists should consider a radical departure from standard operating procedure by severely curtailing, if not outright discontinuing, the routine and regular use of antibiotics for acne.


At the outset of the 20th century, infection was the primary cause of worldwide mortality and the concept of antibiotic therapy was essentially wishful thinking. Needless to say, modern medicine has made major advancements since Alexander Fleming's discovery of penicillin in 1928. Increased public health awareness, widespread availability and utilization of immunizations, better sanitation practices, and greater usage of a myriad of antibiotics have all led to infection becoming only the fourth leading cause of mortality in the 21st century. Antibiotics are powerful medicines that can limit bacterial growth and kill bacteria. However, accompanying the growing use of antibiotics, a new and serious problem has emerged: namely, the expanding development of antibiotic resistance. In fact, antibiotic resistance has become the preeminent public health concern in modern medicine. Drugresistant organisms often necessitate the use of second or even third-line antibiotics, which are costlier, possess less favorable side effect profiles, and may be unavailable in many parts of the world. With a decreased number of new antibiotics entering the medical marketplace, the problem of antibiotic resistance is further compounded. In dermatology, prolonged antibiotic use in the management of acne has become a common standard of care. In the milieu of antibiotic resistance as a public health menace, is it possible that dermatologists should temper their reliance on such agents and consciously step away from antibiotic use in favor of other acne treatment modalities?